CodeBlue614 t1_j34zibf wrote on January 6, 2023 at 1:56 AM

Reply to comment by waltwhitman83 in Family Statement for Damar Hamlin by ShepherdsDoof

There was a report that he had been pronated (turned face down) during the first 24 hours. We really only do that when patients have severe respiratory failure needing high ventilator settings. In this case, it is common to have saliva, vomit, or refluxed stomach acid go into the lungs during CPR, which we call an aspiration event. It is also common to have lungs contusions (essentially bruises) from CPR. Either could cause him to need high ventilator settings early on.

The decision to pronate (flip the patient face down) is based on the ratio between oxygen level in the blood stream to amount supplied by the ventilator (the atmosphere is 21% oxygen, ventilators are usually set between 30-100%). These patients also get chest x-rays using a special portable device, and that x-ray combined with the ratio I mentioned can give you a pretty good idea of how bad things are, even without the CT scan. The problem with the CT scan is you have to leave the ICU on a portable ventilator to get it, so there’s some risk involved if the patient is unstable. I will often delay CT scans if I think they’re too risky for the info I expect to receive.

Without knowing his current ventilator settings, it’s hard to know how much longer until he comes off. He’s probably on little to no sedation currently, since he’s writing. Believe it or not, patients tolerate the ventilator with very little sedation much of the time (sometimes none). Typically we don’t keep sedation that light if the ventilator settings are really high, because there’s so little room for error if the patient and ventilator stop being synchronized. I expect he will get the opportunity to show he’s ready to come off the ventilator every morning going forward, and they’ll take him off when he can past those tests.

waltwhitman83 t1_j35b9r1 wrote on January 6, 2023 at 3:20 AM

what tests does he need to perform/pass in the morning(s) before being taken off ventilatior? understood that putting it back in, not easy

CodeBlue614 t1_j35ors4 wrote on January 6, 2023 at 5:11 AM

First step is just being on low enough ventilator settings. I usually want to see the oxygen no higher than 40%, because that is similar to what a regular nasal cannula can do. Second is waking up and following commands when the sedation is turned down or off, which he’s already doing. Third is called a spontaneous breathing trial. The ventilator mode is changed so that the patient has more control, and we see how they do with minimal support. Usually, that lasts for 30 minutes, but we might do 1-2 hours if we’re worried about how things are going to go. If the patient’s breathing becomes rapid and shallow, they aren’t ready. Finally, we check a cuff leak. The breathing tube has a balloon shaped like a donut called a cuff that forms a seal against the trachea. We deflate the cuff and check to see that air can escape around the breathing tube. It’s a way to screen for upper airway swelling.

You certainly don’t want to be taking the tube out and putting it back in repeatedly, but there will be times when it has to go back in. In Damar’s case, he’s young and healthy and it’s only been a few days, so I would expect he does well once it comes out.

waltwhitman83 t1_j36cjfy wrote on January 6, 2023 at 9:54 AM

how would they know he’d “wake up” and his brain would be ok enough to follow commands instead of letting him sleep 2-5 more days in a coma?

CodeBlue614 t1_j36st7w wrote on January 6, 2023 at 1:02 PM

There’s no way to know when/if he will wake up at the beginning. Usually we try to use the least sedation possible to keep the patient comfortable (based on non-verbal signs) and in synch with the ventilator. If that can be achieved with a low to medium dose, then the patient can wake up once their brain recovers enough. If he’s condition had been such that he needed deeper sedation, then sedation would be lightened when those other problems improved.
The brain isn’t going to benefit from the sedatives, especially at high doses. The more time a patient spends on high-dose sedation, the more confused they get. Sedation is dosed at “just enough to get the job done”. The nurses have protocols for adjusting sedation doses based on what’s going on. If you every hear of someone being in a medically-induced coma, think of it as a necessary evil to help facilitate other therapies to support one or more failing organ systems, rather than a therapy in and of itself. There are rare instances when the sedation is the therapy (e.g. continuous seizures that we can’t break), but usually it’s there to facilitate other therapies.