Why is it necessary to wake us?

[patchworker]

Does anyone know why we can't be put into an induced coma while on a ventilator, and just woken up after the ventilator is removed? It would be so much less damaging. They spend so much money saving our bodies, while they harm our minds.

[ICUsteps-Peter Partner ICUsteps]

Hi Patchworker. I was in the position you described when I was critically ill. I can remember nothing from the day before my accident until after my tracheostomy had been removed over two weeks later. This missing time on top of the drugs used to treat me, the sedatives and my underlying head injury meant that when I did come out of sedation it took weeks before I could think straight and months before I was back to normal. I believe deeper and longer sedation used to be more common than it is now but it was found that sedation itself causes psychological issues, partly due to the specific drugs used. Perhaps someone who's medically qualified could give a better overview of current knowledge and developments in the use of sedation and sedation holds?

I can very much appreciate the desire to just wake up when it's over but sadly it's not quite that simple. Critical care is still a relatively new discipline compared to other healthcare areas but there's a lot of research and hard work going on to try and minimise the negative impact that some of the life-saving interventions and treatments can bring.

[engraved]

I'm not an intensivist/ anaesthetist but I am a doctor as well as a ITU survivor so maybe I can answer a couple of things simply. If they don't help then feel free to discount them.

The drugs that put you into a "coma" are themselves hallucinogenic - so as Peter said sedation can cause psychological issues rather than necessarily alleviate them. There is research all the time into "cleaner" sedation and I am not up to date on the latest drugs.

The deeper the sedation, the higher the risk of respiratory infections both during and after sedation. If you already have breathing difficulties such as asthma or are a smoker, you would already be at high risk, and acquiring pneumonia on a ventilator can be fatal.

The longer a person is on a ventilator, the lower their chances of coming off it. It's not as simple as withdrawing the sedation and everyone will wake up straight away - some people take a long time for their own breathing to kick in, so there is a far longer time of being more awake but still being ventilated. Some can never be weaned from the ventilator. It can be difficult to predict who this is going to be, so who could be "safely" sedated for longer is not that clear cut.

You are right that the focus is overwhelmingly physical - and I'm in the middle of going through my feelings and memories now, so I get where you are coming from - but most of the time it has to be. We wouldn't be here otherwise. I hope this is in some way helpful.

[Asona in reply to engraved]

"The longer a person is on a ventilator, the lower their chances of coming off it. "

In regards to above what's really considered LONG?? Is there still hope of seeing ICU patient weaking up/ making progress if they exceeded a certain weeks of being on ventilator? Let's say exceeding 5 weeks.....

Thanks much Doc...blessings!

[patchworker]

Thank you Peter and Engraved,

I was doing well after my esophagectomy but on the 9th day post op. I developed a high temperature and sudden pain, I remember telling the nurses the pain was "bad bad bad bad

bad". my mind said "alright, they know now" but my mouth kept saying "bad bad bad".

An endoscopy found I had an anastomosis leak, a chyle leak, and a duodenal ulcer which had perforated, and subphrenic abcesses, And then pneumonia. And C. Diff.

I was ventilated for eleven days and in ICU for four weeks, and in hospital for eight weeks.

That was almost three years ago, But though I'm so much better now, the horror of ICU still lingers.

I understand it had to be. I think it's the third anniversary coming up that's brought it back to me.

Isn't it strange how we remember some things so clearly, but can't remember what we had for dinner last week!

[Kulta]

Hey, I agree and this is something I BEGGED for to be done every time I came around from multiple operations and what i wrote on the yellow pre-op consent form following waking up once and desperately trying to remove it - I couldn't communicate other than the sheer physical panic and tears as I couldn't scream in fright. I was petrified so could not be calmed. I think staff sedated me again but thankfully that was the last time I woke up intubated. I think I was told extubation wasn't done in case I needed to have to go back to surgery as complete sedation/induced coma wasn't good for me - I was in and out of theatre eleven times in quick succession. Agreed, one of the more harrowing experiences and seeing another patient nearby go through the same motion - trying to remove the tube - was heart wrenching too. Good luck in your complete and full recovery!

[patchworker in reply to Kulta]

I remember waking and trying to understand what had happened, and feeling for the tube., and the nurse's voice saying "put your hands down Jane, put you hands down" over and over. I wrote "how long?" and when she said "just a few days" I made a wrist cutting motion, asking her to kill me. Death seemed preferable.

I do hope they find a kinder way to save lives. I had the tube down my throat for eleven days.

[Mike-N]

Thankfully I do not remember hardly anything at all about my 2 weeks stay on ICU, because the thought of waking up intubated has for as long as I remember terrified me (even years before I became ill I made my wife promise me that she would not let any hospital put a pipe down my throat, (but in the end to save my life she had no choice, or maybe she did not have any choice at all?). In three different hospitals over the years they have tried to do an endoscopy under local anaesthesia, but every time they have been unsuccessful because I struggle so much and they were worried about their equipment. On the third one I asked them to give me a general anaesthetic, but he was so arrogant claiming there was no need because he had never failed yet. Well I guess I was his first one LOL.

Funnily enough it has just hit me that I do remember calling nurses and being totally ignored, until I started waving and one of them saying you cannot talk because of the thing in your throat, but it never hit me that it was a pipe because as far as I was concerned I was talking to her, I REALLY WAS convinced that I had both talked to her and called other nurses (did anyone else think they were talking when because of the pipe and the drugs they obviously were not?). So I have always put it down to me having one of my dreams.

It was obviously the drugs that wiped my memory, because my first real memories were from 4 days after they moved me from ICU to the ward, but even then the hallucinations and actually hearing and seeing things that did not happen didn't stop, and I still to this day get the dreams and nightmares, and even though I hate what the drugs and being in the ICU has done to me mentally, I thank God that they kept me from realising I had been intubated or even that I was in ICU.

Just thinking about what I would have done if I realised that there was a tube in my throat does not bear thinking about and if they tied me down it would have just made things worse, because part of the reason I was in there was because I had had a heart attack, so it would not have done my heart much good.

Patchworker I agree with you 100%, they should do something that keeps everyone from knowing that they have been intubated until the pipe is taken out.

Good luck, both to you and everyone else that is still suffering mentally from there illness and stay in ICU.

Mike

[Mystery]

I am confused!!

I was ventilated for 3 weeks and during that time had a thoracotomy op, I do not remember being woken , I remember the hallucinations, eventually woke and moved to step down , I don't understand the question why are we woken, sorry if I am being 'special' can anyone explain ?

[patchworker in reply to Mystery]

Hi Mystery,

I suppose I meant why did they stop the drugs that were keeping me sleeping.

You say you woke up, but they allowed you to wake up, just as they had been keeping you sleeping before. They control everything while we're in ICU. Wouldn't you rather have slept on until it was all over, if it had been possible?

One problem I have, I can't remember the order in which things happened. I remember the horrific nightmares, I suppose they must have happened while I was asleep, so I should be glad I didn't sleep any longer.

[Mickey1965 in reply to Mystery]

My mom was woke up whle in a vent and was ask if she wanted a thoracotomy my siblings wouldn't allow it so I was out numbered and once they took her of the vent it was only 5 days she passed she was at Gateway Hospital in Clarksville Tennessee they are a terrible hospital

[Luckyone]

Hi everyone, I was intubated for 19 days and then had a tracheotomy I can remember none of it being done only waking up after seven and a half weeks to find a breathing tube attached to my throat, I had been sedated most of this time, my wife told me I had been awake for short periods during that time but had to be sedated again due to my condition, I can remember the nightmares I had when sedated, so vivid as if things were real and then the hallucinations after I was brought out of sedation feeling just as real and sometimes very frightening, my wife was warned by the consultant that I may get ICU delirium due to the long period of sedation along with the powerful drugs I was treated with. I finally had the tracheotomy removed 78 days after being admitted to ICU, I left ICU after an 88 day stay.

[Hidden]

I was woken up on the ... 3rd day of my coma (I think, I have very little memory), but re-sedated because I kept trying to pull out the ventilator tube. It was truly the worst thing I have ever had happen to me. I found it impossible to eat for a couple of days after because I was too scared of putting anything in my mouth

I only started eating again after the dietician threatened to put the nasogastric tube back in!!

[Kate04]

Thet are trying to wake my father up after being sedated for two weeks. The doctors already stopped his sedation a few days ago, but had to keep the tube to make some other investigations. He woke up a few times, one day he was very agitated and moved his head a lot, two days ago he opened his eyes and recognized me and then they sedated him again yesterday because he was again agitated. Today he was calm and said they will try to remove the tube. Could someone please advise me about what should i say to him?

[cmeblu]

How is your father doing? I'm in the exact same position with my father right now. I see yours was 9 mo's ago. I'm wondering what type of care they'll need when they leave the hospital? He's on no sedation for 4 days, and no narcotic pain meds for one day. We're waiting for him to wake up. My dad woke agitated a few times and was put back on sedation, but he's good now. By good I mean that he's doing most the work, breathing mostly on his own, but still has the tube. They actually tried taking out while he was sedated, but had to put it back. That was upsetting!! How long does it take to wake up? I know everyone is different, but what's keeping them from waking? The dreams?

[Hidden in reply to cmeblu]

My dad was placed in an induced coma and is into his 4 TH week. They took him off meds a week ago. He wasn’t coming round by day 5. Initially there seemed to be movement but then nothing and they were going to do a brain scan. Then next day he had his eyes open and is able to squeeze his wife’s hand. My advice is don’t judge by others as it really is an individual thing. He will wake when he is ready. They have sedated him again tonight because he is agitated but hopefully they will take the tube out soon and he will be able to breathe on his own. Don’t give up hope even if your dad isn’t following the usual trend.

[Asona in reply to Hidden]

Do you know what's the longest one has been on ventelators and pulled through...is there hope being on it for over 4 weeks...thx much and gods blessings🙏

[Hidden in reply to Asona]

My dad was in a coma and ventilated for 5.5 weeks. They were talking about a tracheotomy but this didn’t happen in the end as he fought the infection. It took him another week to come round and fully come off the ventilator. He is now out of hospital and recovering well. The most significant change is the muscle loss but we hope he will build that up again over time.

[KellieDoris77]

I was on a ventilator and wasn't given enough sedative so woke up and ripped it out taking my vocal cords with it, so they strapped me down and gave me heavier amounts. I too can remember the delerium, like nightmares now, but completely real at the time. Hallucinations weren't the worst part though. I couldn't get to breathing on my own after only 2 weeks Vfintubation, so they forced the tracheostomy which requires a feeding tube because you cannot eat or drink (not even water! For a week and a half, awake and sooooooo thirsty. Then, finally they removed the trache (they literally ripped it off unsedated on my hospital bed). Then I had to have a swallowing xray to see if my vocal chords healed and was given the approval to DRINK! and eat. As soon as I got back to my room I wrapped my lips around the faucet and drank and drank and drank until they gave me a cup with yummy ICE! that water was like manna from heaven.