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Anesthesiology/father-in-law on ventilator

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QUESTION: Hello Dr. Levy,

My father-in-law overseas has been hospitalized with a lung or some type of respiratory infection and he cannot breath on his own.  My wife traveled 20 hours on an emergency flight and said they are keeping him sedated full time.  They said he needs sedation so his body does not fight the ventilator machine.  Does this make sense and do you feel this is a reasonable explanation or approach?  I cannot understand why they cannot allow him to come out of sedation for a short time to see and speak to his daughter which may give him some inspirational support.  The family overseas feel that the medical staff there have been unprofessional and not very responsive and we have no other means to question their approach.  Please let me know your thoughts.

Thank you,
Sanjay

ANSWER: Not knowing the details, it is hard to answer but, in general, if he has a respiratory infection, it is not unusual to sedate him. Let me explain why. When you have an infection in the lungs, it takes a lot more work to breathe (using your respiratory muscles, etc). By putting the patient on a ventilator, the ventilator takes over the work of breathing. So far, so good, but if the patient is awake (and on a ventilator) it is very uncomfortable for several reasons; 1) a machine is pushing air into your lungs (when it wants to, not when you want to) and 2) if you do try to take your own breath, it is like trying to breathe through a straw. By sedating him, it allows the respiratory muscles to rest, the infection to heal and also makes him more comfortable. When they are ready to get him to breathe on his own, they will start reducing the sedation and he will take over more of the work of breathing with the machine just serving as a safety backup until finally they can extubate him.

So while I know it is not pleasant not to be able to interact with him, they are probably doing the right thing at this point.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

---------- FOLLOW-UP ----------

QUESTION: Hi Dr. Levy,

I had an update and follow-up question regarding my father-in-law overseas.  He does indeed have pneumonia which they started treating about 1-2 days ago and during that time his oxygen dependency went down from 85 to 65.  My question is can they very soon take him off the ventilator and move him to mask?  The reseaon for my urgency is that he's had hip replacement surgery in the past and they just found out yesterday that his hip had popped out.  The nuerosurgeon says they cannot fix the hip while he is on the ventilator. The hospital says they will wait about 3 days to remove him from the ventilator assuming his condition continues to improve. It must be very painful for him to lie there with the hip dislocated. Do you think it is reasonable to wait 3 days or can they remove the ventilor sooner, to allow fixing the hip?  

Thank you,
Sanjay

Answer
Why is a neurosurgeon talking to you about a hip dislocation? That should be an orthopedic surgeon. It makes no sense because leaving the hip out has its own risks and complications. In either case, there is no reason they can't relocate the hip while on a ventilator. In fact it is easier because they can give sedation or anesthesia to do that because of the fact that he is intubated. If they are planning on doing that procedure open, then it makes sense to wait until the infection is over so they don't infect the prosthesis but other than that, there is no reason why they can't fix the hip. As for the ventilator, that will entirely depend on his condition improving and his ability to breathe on his own. There is no way to put a time on that. As long as they continue to progress in that direction then there is nothing to worry about.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

Anesthesiology

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Ronald Levy, M.D.

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Associate Professor of Anesthesiology, University of Texas Medical Branch at Galveston. I am a board certified anesthesiologist who can answer all questions related to any type of Anesthesia with the exception of Pain Management.

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