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.