heart bypass surgery complications

My husband had emergency double bypass heart surgery 6 days ago and he still won't wake up.  The doctors are saying he is scattered brained.  He has been tested and there is no evidence of a stroke.  His eyes don't focus and he flings his arms and legs around and he won't follow any commands.  It's like he is not there.  He is still on the breathing machine at 35%when he came out of surgery, he was at 100%.  Can anybody help me with some information?  Is this just a waiting game or is there something wrong?

[ed34]

Is "scattered brained" a medical term?  His breathing machine is virtually at normal now
so it does show recovery. Do they feel that maybe he reacted badly to the anaesthetic?
I'm not sure why he would be on a ventilator for so long, did he suffer from post op trauma
which usually results in the lungs becoming very inflamed? You need to ask the doctors
for their official diagnosis. When on a ventilator, it is very common for a patient to be
heavily sedated to prevent panic, this may account for the eye rolling etc.

[pjajmv]

The doctors labelled it as scattered brained. Ed34, you helped me by telling me that the sedation was making his eyes roll backwards etc. and I thank-you for that.  This was emergency surgery and they are concerned about his respirator system because he is a smoker and there are a lot of secretions in his lungs.  Scans showed last friday that there was no damage in the brain to suggest a stroke, but now they are thinking about doing another one.  When they try to take him off sedation, he does move arms and legs, but he also tries to pull the tubes out to.  My thoughts are could this be too much for him because he didn't have time to accept that he was going to have surgery or was it done during the by-pass operation and I don't understand what you mean by post op trauma because I feel that since the operation the whole thing has been trauma.  He can't breath on his own yet his head isn't clearing up, but the heart works fine.  Any other help would be wonderful from you or anybody else.

[kenkeith]

Your husband appears to be in  a coma. . Individuals in such a state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns.  Although individuals in this state may appear somewhat normal, they do not speak and they are unable to respond to commands.

Individuals may emerge from coma with a combination of physical, intellectual, and psychological difficulties that need special attention.  The outcome for coma depends on the cause, severity, and site of neurological damage. Individuals may emerge from coma with a combination of physical, intellectual, and psychological difficulties that need special attention. Recovery usually occurs gradually, with some acquiring more and more ability to respond.

Some individuals never progress beyond very basic responses, but many recover full awareness. Individuals recovering from coma require close medical supervision.  Your husband's condition cannot be anything but a coma based on the information provided.  Scattered brain is a bogus term related to this condition, and has no medical meaning.

[ed34]

My wife was on a ventilator in July. She had what was supposed to be routine surgery but unknowingly had a small chest infection. Weakened by surgery, and her immune system weak, she developed post surgery trauma thru pneumonia. A ventilator was required due to her lungs having fluid and being swollen. She was heavily sedated and
showed the exact same symptoms you describe. She describes it as being half in reality and half not, and not knowing which one is one. I was told she would not make it
through the night and she did. I was told she would be on the ventilator for 6 weeks, she
was on it 5 days. I was told she would need oxygen for 2 years, she needed it for 1 day.
Nobody can say anything for sure because it is all down to the patient. My wife is a heavy smoker too, her lungs had to be suctioned every 30 minutes to remove the liquid
cigarettes from her lungs (30 years worth). After 4 days her lungs were virtually clear and
they decided to stop the sedation to let her wake up. The following day they removed the
tubes but she was still rolling her eyes and not making much sense for another three
days. When in sedation, you are not quite in a dream state but half way there and
moving the limbs was a common thing with my wife. The ventilator has many readouts. It can tell you how many breaths are being taken by the patient and how much pressure the machine is putting into the lungs. On day 1 and day 2 the machine was doing all the work. On day 3 my wife was taking 10 breaths out of every 20. On day three the pressure
was lowered. On day 4 she was breathing without the need for the machine but they kept it installed for 24 more hours to be safe. On day 5 it was removed. Keep watching the machine, ask someone to explain it. It will show you any improvements, no matter
how small. As long as his Oxygen is sufficient in the blood, there should be no problems.
Blood gas tests will be frequently taken to measure this. I saw patients that had been on ventilators for weeks.  Some had been taken off ventilators then put back on because they were taken off too early. Patience is a virtue and its better to keep ventilating until the patient can DEFINITELY breathe on their own.

[pjajmv]

Thanks to everyone who has written,
He is awake and still on the breathing machine.  They are thinking about taking him off it today to see how he does (worst case, they put him back on it)

[ed34]

please be very careful here. Those who are put back on end up being on the machine for a much longer period of time. If they feel unsure, wait another 24 hours. I cant emphasise how patience is a virtue here. I witnessed lots of patients being put back on ventilators and I saw some who had to have them turned off after the second attempt because recovery had failed. SO I really urge you to make sure he is ready.

[pjajmv]

They took him off the breathing machine on Friday without me there and he could not breath on his own and had to be put back on the machine.  The doctor looked in his lungs and everything looked good.  They can't figure out why he can't breath and also why he has had a fever since Aug 25.  When they put the new tube in him, they put a suction device to clear secretions in his chest.  They will decide on Tuesday if he is not better whether to do a tracheotomy.  They are saying that they don't know why, but there is a higher sucess rate when they do this.

[ed34]

It's true what the doctors say, but I really believe he was taken off the ventilator too early.
Tell me, was he fully conscious when they did this? fully off the sedation and wide awake? This is very important because usually if a patient is still half sedated they tend
not to breath on their own. This is why we have to be ventilated during general anaesthetic.

[pjajmv]

I believe he wasn't sedated and was awake because they did not sedate him the night before and he was waking up through the night.

[pjajmv]

The doctor has decided to do the tracheostomy.  They believe he will do better after this process.  Any comments on this would be very helpful.

[ed34]

a tracheostomy does produce better results the second time around. Sedated, awake or not, taking a patient off too early is all too common and unfortunately this is very hard to judge. My local hospital tends to add 24-48 hours from the time they believe they can be
removed, just as a safety measure and depending on age.
Are they sure he has no infections now? is there much fluid in his lungs to be extracted?

[pjajmv]

Hello,
They had him scheduled to do the tracheotomy today (Wednesday) and they gave him one more chance to breath on his own this morning.  He has been breathing on his own all day, he is talking and eating ice cream, apple sauce and jello.  The staff seems very pleased with his results.  They said he just turned a big corner.  He seems disoriented  from the medication he was on but they say this is normal.  They tried to have him stand today, but he is weak.

[ed34]

Im so so so pleased. Believe it or not I have been thinking about him a lot. He really
has turned a huge corner. He will be weak due to malnutrition but will soon pick up
now he's eating again. Being fed through tubes doesn't give the same level of nutrients
in the blood as through the digestive system. Once his nutrition bumps up, you will
see a very fast recovery. He must be a real fighter to get through this so quickly and
I'm sure you must be very proud of him. Is he able to cough properly to clear out his
lungs?

[pjajmv]

Yes, he is able to cough properly.  Thank-you so much for all your help through this.  You were a big support for me at this time.  

[quincy62]

I know you posted this 4yrs ago but now my husband who had bypass surgery 3days ago has not fully waken up other responding to verbal commands. I believe it is due to the last pain meds he received when he kept trying to pull out his ventilation tubes that has now been removed and hes breathing fine.

[bfuller83]

My uncle from Oklahoma suffered a heart attack he was at home and when he would lay down he couldn't breath. I was told he was like that for 2 days before his wife gave him no choice and took him to the hospital. From there they life flighted him to another hospital from there he was life flighted to hillcrest heart hospital. He was very scared and kept asking the doc what his chances and is he going to die. Currently things have not went well.... He had 4 bypass surgery and I was there when the doc came n and said we were. 99.9 percent out of the woods and he should recover and have much more energy and quality of life, well. Then they knew something was up when he wasn't waking up then that night he suffered what the doc quite a " massive stroke to the right side" now he is paralyzed on his left side. Today is day 3. He is still not awake and he only responds with some movement from his wife's voice. She asked him to move or wiggle his fingers and he does and that's about as far as it goes. Please please does anyone know what happens from here what is to be expect from here? Any advice would be much greatly appreciated!! Thank you !!

[ed34]

Over time, much of the function should return. It will involve physiotherapy and a lot of frustration for your Uncle though. My wife suffered a massive stroke which too resulted in complete paralysis of right side, but within a year she was walking and doing all the things she used to do. It took a LOT of work. When he is feeling a bit better, start giving him things to use with his hands, such as squeezing soft objects, picking them up and putting them down too. Hold them at different distances, and ask him to take them from you to get hand/eye co-ordination back. The thing is, another part of the brain needs to learn these functions from new, like a baby. He has to make new connections in the brain for such tasks and let them become permanent. The brain does have these abilities, and don't listen to Doctors when they say there is a 2 year limit for this, there is no limit. The brain can go on for the rest of the persons life making connections. Even now, we all make millions of new connections and break old ones every single day. Don't let it worry you, the more work you put it in, the better the results and they will amaze you. Memory loss may also occur temporarily too, which can get you worried. However, over a few months it all starts to come back. I used to show my Wife old photos and talk about old times. She had lots of memory fragments in her brain which just needed joining together again. It's good they have resolved his heart problems. It can take a while for patients to feel 'awake' from sedation too, some take a few days. We don't all jump up and start talking when sedation stops. I sometimes think that Doctors are a bit impatient.

[jess0820]

My uncle just had quadruple bypass surgery Tuesday they said everything went fine and he was doing good. He is smoker. Well when they took him of the ventilator wednesday it was like he started panicking and saying he couldn't breathe so they put him on a oxygen mask (it was like a cpap machine) and then his oxygen level got back up to normal and he got worse he started pulling it off saying he felt closterfobic and he was stressing he self out. They put him back on the ventilator that night cause they said he had worked himself into a frinzy and had a lung doctor come in and he said everything looked good to him so he called and asked if he was a drinker and he hasn't a drink in like 5 years he said it looked like he was having with drawls from no alcohol that's it. And they still cant tell us why he is so aggravated, panicking, filling like he cant breathe. Im just lost because he is NOT a up tight person he dont stress out like what i have seen since the surgery. He is very laid back and calm and collected. They cant tell us if it is from the nicotine with drawl or what but he still on the ventilator and heavily medicated to keep him calm and asleep. If anybody could help it would be great.....Thanks

[ed34]

People react in many different ways to such traumatic surgery, and a bypass is traumatic. He must have been in theatre for a few hours. I can't understand why they didn't give him some sedation while on the Oxygen, perhaps they tried I don't know. The trouble is, he needs to come to terms with what has happened, and being out cold he isn't going to do that. Maybe they should try reducing the sedation enough so he is just half awake. This way people can give him reassuring words of comfort. The mental side of recovery from bypass or any traumatic surgery can be overwhelming for some people. I remember after bypass surgery, they removed the respirator tube and everything felt very different. The tube did all the work for me and there was no discomfort from surgery at all. When the tube was removed I had to do everything for myself, and expanding my ribs to draw air into my lungs was both painful and hard work. For about three days I could only take short, sharp breaths and it makes you wonder if you are getting enough air for your body. I can understand how he feels, and I truly sympathise. There is also the fear that your chest is simply going to fall apart. He needs a LOT of reassurance and to be told his chest is not going to open, and some discomfort is normal.