precoma

my grandma (Age 76 yrs) is in pre-coma.she responds sluggishly to painful stimuli.she was intubated 6 days back as her blood oxygen saturation fell down to 20-30% while doing procedure of ryle's tube insertion.since then she is on ventilator in iccu.o2 saturation was immediately restored upto 85 % and she responded to verbal commands after this episode.she developed multiple infections... blood culture showed e coli,candida ...she is on intravenous- linezolid,itraconazole(oral),amphotericin B,meropenem and colistin antibiotics. her chest x ray showed congestion and changes of ards which has recoverd well in last 2 days.but her kidney is suffering from acute renal shutdown.so dialysis is advised and one cycle is already administered.doctors here are suspecting brain damage either due to infection or due to cerebral hypoxia episode.if it is due to infection there's a hope that it is reversible.her total counts are increasing its abt 32000 /cu mmtoday.please reply if any higher antibiotic or some drug which can improve her condition can be suggested.

[Dr Sharma]

Hi there, I understand your predicament. Her leucocyte counts are quite high and would be due to infection. She is already on multiple antibiotics incl. meropenem and culture sensitivity would have been done. Cerebral hypoxia and its duration would determine the prognosis. Renal shutdown if prerenal needs a trial of fluid challenge. ARDS has improved which is a good sign. Careful watch needs to be kept of circulatory collapse and appropriate vasoconstrictors and ionotropes would be required. The intensivist looking after her is the best judge. Hope this helps. Take care.