Is a tracheostomy the only option after hypoxic brain injury and seizures?

https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-is-a-tracheostomy-the-only-option-after-hypoxic-brain-injury-and-seizures/

Quick tip for families in ICU: Is a tracheostomy the only option after hypoxic brain injury and seizures?

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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, we are currently working with a client who has their 36-year-old daughter in ICU after cardiac arrest, after drug overdose. She’s been in ICU now for about a week. The MRI (Magnetic Resonance Imaging) of the brain says there has been some significant hypoxic brain damage done, and she’s now also having seizures. Now, she was in cooling therapy initially, and how the intensive care team is saying after only about a week in ICU, that if she does wake up, she will be a “vegetable”. And the only options are end-of-life, or to do a tracheostomy and a PEG tube.

Now, a week in ICU after such a traumatic event is not a long time and even ICU teams don’t have a crystal ball to predict the future. So, the client wants to know, “Are there any other options besides moving forward with a tracheostomy and a PEG (Percutaneous Endoscopic Gastrostomy) tube? Or can she be extubated?”

Now, the reality is that an extubation means the breathing tube is being removed. Now, the reality is that if she’s not waking up, she won’t be able to be extubated. But the whole notion that this lady will be a “vegetable” is a terrible notion and should not be used by health professionals because health professionals know better. There are neurological assessment tools, i.e., Glasgow Coma Scale, and any suggestions around the future should be done around the Glasgow Coma Scale and not with using inappropriate terms, such as being a “vegetable”. Doing assessment on the Glasgow Coma Scale, if the Glasgow Coma Scale is 3, fair enough, that’s the lowest it can go. If it’s an 8, it’s somewhere in between. So, it’s about making appropriate assessments and not using terms that are degrading to patients.

So, where to from there? The seizures need to be under control as a first step. And once the seizures are under control, then assessments can be made about how to wake up this lady. Can she wake up? How much time does she need? Is a tracheostomy the next right step? The reality is, if she’s not getting a tracheostomy, she won’t be having a chance of waking up. So, it probably is a case of doing a tracheostomy, giving her all the time to control the seizures, and then let her wake up, start with doing some physical therapy, if that’s possible. And then, once the seizures are under control, then it’s a case of starting to mobilize this lady and see whether she can, or she can’t wake up.

It’s a waiting game and it takes time. Sometimes it takes weeks, sometimes it takes months, who knows? But one thing is for sure that if treatment is withdrawn, there is no return from that. And I want to leave you just with that thought for today. If you withdraw treatment, there is no return from that. If you do a tracheostomy, then there is time for patients to be reassessed and there is time for them to wake up to what is possible.

That’s my quick tip for today.

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