Does a more aggressive recovery plan seems in order now?

[patriciadani]

My 75yr old mother just had two tumors removed from her colon (large mass blockage lodged immediately after small colon and a slightly smaller mass two inches before rectum)with a temporary colostomy(6 months to heal) . She has a history of low blood pressure and the first attempt for surgery failed after anesthetic was administered because blood pressure dropped but the second attempt was sucessful(they were prepared for it this time). Surgical site healing nicely BUT doctors are having three major problems: 1) getting blood pressure up (90/35 with  two separate blood pressure drugs in IV), 2)weaning her off the ventilator, and 3)retaining fluids which have resulted in her experiencing congestive heart failure. She was awake and alert after surgery but with the Ativan and Demerol IV an RN told me she is in chemically induced unconsciousness (because of the pain of the tube for the ventilator).  I feel she should be alert enough to fight for her life is she has to.  I don't think a patient can fight sedated so heavily.  I am afraid the hospital is letting her "slip away".  My mother (I have power of attorney) WANTS TO LIVE. She has a happy, good life. She would not want to slip away.  I would rather see the ventilator tube be pulled and her trachea'd and awake and able to communicate.  Any time she has surfaced after surgery she goes nuts trying to ask questions we can't figure out. This may sound hard but I bet experiencing some discomfort may do the trick for her low blood pressure.  Does a more aggressive recovery plan seem in order now?? Patricia Danis

[Kevin Pho, MD]

Hello - thanks for asking your question.

You describe your mother who is after surgery and on a ventilator.  Your description does not sound like the doctors are letting her slip away.  By keeping her ventilated, it seems that they are being as aggressive as they can.

Mechanical ventilation with the breathing tube is generally not comfortable for a patient who is awake.  There is a natural tendency to "fight" the ventilator, causing discomfort.  That is why it is much more comfortable for the patient to remain sedated while ventilated.  

It is only during the extubation and weaning process where you would want the patient to be awake and breathing on their own.

As for your mother talking - that would not be possible as long as she is intubated.  

As for the tracheostomy, that is typically considered if they are unable to extubate after several weeks.  

Regaring "code status" or advance directives.  These questions are routinely asked in the intensive care setting - I would not interpret that as a definite sign that things are deteriorating.  Physicians typically would ask these questions beforehand rather than during crises.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[kimbacat]

Patricia,

not a doc, but I have had quite a few major operations and lots of complications.  

it takes a lot of energy and time to recover from surgery.  you need to let her heal.

pain (it's not discomfort, it's pain) while it might raise her blood pressure, it will stress her body even more.  

for the times that your mom is more conscious, get her a pen and paper.  if she isn't able to write, then make a simple board or flash cards that you can point to and have her acknowledge yes or no.  put simple words like:  hot, cold, hurt, yes, no, itch, the alphabet, etc.  

talk to the team of docs that is treating your mom.  express your concerns and work out a plan.

[surgeon]

it certainly sounds like they are not in any way letting her slip away; you describe aggressive and appropriate treatment.
Everything we do to treat problems has an upside and an downside; in very sick people, the balance is even trickier. If she is ventillator dependent, she likely wouldn't be able to talk even with a trach, although it's true she might require less sedation. When to do a trach in a ventillated patient is, like every other decision, not black and white. Usually if it looks like they'll be off the ventillator in less than a couple of weeks, the trach isn't done. But every situation is different. It sounds like she is suffering a degree of multi-organ failure, which is seen in severely ill and/or septic patients. It's a potentially lethal situation; sometimes recovery is aided by reducing her stress by keeping her sedated. But you are certainly entitled to information and should indeed be expressing your concerns to her doctors.

[patriciadani]

THANKS FOR THE INFORMATION, I ALREADY FEEL A LOT MORE RELIEVED. I THINK I PANICED TWO DAYS AGO WHEN THE SURGEON ASKED HOW FAR THE HOSPITAL SHOULD GO IF MY MOM "CODES" ON THEM.  IT SHOCKED ME SO.  OF COURSE, I SAID "ALL THE WAY, EVERYTHINK!" THANKS, AGAIN. PATRICIA

[Katerina19]

A related discussion, Please help, coming off a trach was started.