Intensive care unit Q

[ineedanswerstothisPLS]

Hi. I name changed because I don’t want this associated with my usual name. I’m embarrassed even though I don’t know why. I know there is no shame in mental illness but I’m humiliated with my obsessiveness over this.

I was in intensive care with pneumonia and sepsis. I was put on a ventilator. I was taken to theatre to be intubated and my husband said I was gone around an hour.

My hospital doesn’t offer any follow up. I don’t have any medical consultants I can ask.

I was diagnosed with PTSD and trialled on anti depressants and tried CBT. Nothing has really worked. I find it important to know as many facts as possible to help me cope. A huge anxiety for me is because I don’t know what happened to me when I was in the medically induced coma. Obviously husband told me as much as he was there for.

I don’t understand why I was taken to theatre and why it took so long. If anyone could give any sort of explanation or have any knowledge, I’d be really appreciative. Please and thank you.

It would be unusual to go to theatre to be intubated if you were already in intensive care? You were in a medically induced coma without being intubated?

Your memory may be a bit muddled. Contact PALS and ask to see your medical record. That would have full details within your file.

Do you mean you had a tracheostomy? If you did then yes you go to theatre, but for a normal intubation then you wouldn't have gone to theatre x

It wouldn’t be unusual to be in theatre for an hour for a short procedure. Much of the time is waiting around for theatre slot, people to scrub, porters to move you etc.

As for follow up, there will have been a named consultant for your care. Contact PALS and ask if you could meet with them or someone appropriate to discuss the experience- it may be that they will meet you, or that they could ask a nurse who worked closely with you to do it.

PTSD is increasingly recognised as a problem in people who have had life threatening illness like you, it’s nothing to be ashamed of at all. Some hospitals are now offering a follow up appointment to people after a long itu stay to discuss their care and this will probably become more standard as time passes.

(I’m not an ITU doctor but work in an allied field).

Sorry I wasn’t being clear.

I had a normal intubation, via mouth. I was rushed there from ICU and put to sleep very quickly. It was everything after that took such a long time.

I was in the medically induced coma after but I do not remember much before as I was so poorl.

Thank you by the way, I was sobbing just writing this. I am not ungrateful for my outstanding care and treatment. I just am so messed up in the head. My body eventually has healed, my mind not so much....

Please don't feel embarrassed or ashamed
Did you have a tracheotomy? If yes then that will explain going to surgery. Can you request your medical notes? It sounds like you need counseling, PTSD is awful

Sorry you have been so poorly. As others have said upthread, this is not unusual at all. I am sure it would be possible for you to meet with your ICU consultant for the opportunity to ask questions. Agree is unlikely you would have gone to theatre for intubation from ICU, but it is perhaps possible you could have been moved from a HDU bed to an ICU bed.
Hope you get the answers you need.

Can you ring the ITU and ask if there’s a follow-up programme? Ours offers one to all patients and they are able to meet with the team that looked after them, go through their notes to explain what happened while they were there and can ask any questions and be referred for further follow-up if needed.

I’m an ex-nurse, so I’m basing this on a bit of a guess. But I would think that the concern would have been that they may have needed to proceed to tracheostomy if the intubation had failed.

An hour in theatre / recovery isn’t long at all, even though it seems forever when you are the relative and you’re waiting for news!

I would also suggest contacting PALS and asking for a debrief of your care.

Hope you soon find the answers you need and peace in your mind

I was definitely in ICU, my husband said they moved me back to th same bed with the same nurse.

They had said I’d likely need a tracheostomy as (outing self), I’d recently had major constructive facial surgery and I was swollen with no full mouth opening.

Unfortnstrly, there is no follow up program. The icu consultant was a bit of a dragon and I’d be scared to see him again.

I didn’t know I’d be able to get a debrief and I’m also concerned about taking up the time of ITU staff. I know they are busy and over worked.

I’m seeing my GP again tomorrow. I’m sleeping around 3 hours per night which isn’t helping my anxiety.

Thank you all x

I think some of my husbands trauma has affected me too. I think we both need to address it x

Sounds like you were taken to theatre as it is a safer place to do a potentially difficult intubation as there is more airway kit and expertise there.
An hour for a potentially difficult intubation is really quick!!

Contact ICU, there will be more than one consultant, one of them should Be happy to talk you through your notes. There is a lot in the literature to support this being useful for some patients.

Go via PALs if you have . We would arrange this for our where I work in a heartbeat and the person who does it will probably be the cardie wearing consultant!

Please dont be embarrassed. You've been through a massive ordeal and whilst the drs/nurses will more than likely have explained everything to you at the time you were probably still on some of the anesthetic drugs, and dont remember those bits. And by the time you get to the ward, no one takes or, more specifically, has the time to discuss it properly. (I used to look after people post surgery, waking them up and extubating in icu and repeatedly had to remind them surgery was over for instance)

intubations can be done in theatre, particularly if they planned to have a look in your lungs (a bronchoscopy). Some icus might have rules that they do that in a theatre (mind did bedside or in theatre depending on anaethetist).

Please go back to your gp and tell them how its affecting you still. Then get onto PALS, you might have to push for it but if you google "ICU survivors support groups" it will hopefully give you some more information on the support you feel you need.

You might also find it beneficially to think about what it is you want to know. Write all your questions down and use them when writing to PALS.

So if I had a patient with a potentially difficult airway I would move to theatre to intubate as the kit is there if it goes wrong (it's also there on ITU but there's more help) You can also have an ENT surgeon on standby for emergency tracheostomy.
A lot of places have a follow up clinic, if not you could request a debrief.

Hi OP I’m so sorry you are feeling like this I’ve no direct experience but through work have come across this website icusteps.org which may be of interest

Oops. Took so long to type my post ive missed loads.

Yes if they felt it was going to be a difficult intubation then they would have went to theatre.

Dont worry about taking people from their work. This is important for you, and your husband

I hope you find some answers by contacting staff at the hospital. I had pneumonia and sepsis and was in ICU too. I found the mental after-effects took far longer to come to terms with than the physical (even 4 years later I'm not properly over it). I did find it helpful that my hospital kept a patient diary and took photos. This with my family's feedback have helped me piece together the missing time whilst in a coma.

ICU steps really helped me and is something you can both go to.

Right. Everybody is different, and the information you have given in your OP is not very clear, understandably.

Anatomically, everybody is different, some people are harder to intubate than others. Because of the size of the mouth opening, larinx, epiglottis, how far out or back your mandible is etc etc etc. There is an infinite variation.

Facial reconstructions/fractures/swelling/trauma etc also can make intubation hard.
So, if the anaesthetist recognised it as a difficult intubation for whatever reason, they took you to theatre because it is the best and safest place to perform the procedure.

There are a number of things you need to have in place to ensure the procedure is a success. Most and foremost, having the people and the equipment. And who would be best at it than the people who do this day in and day out?
So, they took you to theatre, and it takes time. You are attached to monitors, they ensure your IV access is ok, you are given oxygen for a bit to ensure your lungs/blood carries the best possible amount (of oxygen).
This takes a bit of time.
Then it’s the equipment. There are several types of equipment that can be used. They all have to be lined up, checked, ready to go. That takes a bit of time too. Not that you need them all. But in case you need them, you want them there, ready to just be picked up.
The procedure itself can take some time. There are moments when you try, moments when you wait to see everything’s ok. You’re being monitored for all sorts, oxygen, airway patency, blood pressure etc. This also takes a bit of time.
All in all, one hour is not abnormal at all.

Your best bet is to ask to speak to the anaesthetist. Yes, they are busy, but they are also aware people deal with what happened to them in a different way. Nobody is going to roll their eyes or dismiss you. They want to help you get better. It’s ok, go and ask, nobody will mind.
Can I just say, I’m sorry you’ve been through a rough time. Wishing you healing and peace of mind.

ICU nurse here. Are you sure here is no follow up service? I work in a small hospital, we don't have a lot of money yet we do offer this.

If not I would call the unit and ask to speak to one of the nurses and tell them how you are feeling and would really like a debrief.

There will be numerous consultants.

I agree with previous posters, go to PALS and ask for some help to discuss your admission. There will be a nurse or senior nurse who looked after you who will be happy to go through what happened when you were ill. Reading through the notes on your own might not be the best thing to do as they will be full of jargon and it would be helpful to have someone to put this into context for you. They may be busy but speaking as a nurse we are aware of the mental health issues previous patients have and don’t mind in the slightest trying to help patients with these once they have left the ICU.

Some patients even visit the unit with their therapist to see what it is really like as their memories of the place can be very frightening.

I’m surprised they don’t have any follow up set up as it’s now standard practice to create a patient diary so you can read back day by day accounts of what happened as very few people remember it afterwards.

As for your trip to theatre It isn’t unusual for everything, including trips to theatre, to take a long time for an ICU patient. An hour isn’t that long at all for a tracheostomy as just getting someone so ill who is attached to so much monitoring equipment into theatre takes a while. They will have also made sure you were stable before they brought you back to the unit and often stabilise you before family are brought back to visit.

I’m really sorry you are struggling so much with the after effects and hope that once you have a clearer idea of what happened things will fall into place a bit more and you will feel better x

Hi OP, I have a serious lung condition and have unfortunately been put into an induced coma many times due to pneumonia so I understand exactly how you feel
What you're experiencing is all perfectly normal, it's great that you've been diagnosed with PTSD as it will hopefully open the gates to effective therapy for you.
You've been given some good suggestions here but I would urge you to contact medical records at the hospital and get a copy of your medical and nursing notes, these will allow you to put together a timeline of events.
This will be vital to your recovery as it enables you to fill in the gaps, the drugs used to keep you sedated often cause you to hallucinate and imagine all sorts of things and it's really difficult to know what really happened.
It is very common to suffer from PTSD following induced coma, only someone who's been there understands the desperate need to know what happened in the most minute detail. You are not going mad and you will recover.
Once you have got your notes do go back and make an appointment with ICU and they will be happy to answer any questions you have, it's lovely for them to see patients who have recovered physically and if you take cake you will be welcomed with open arms.
Keep chatting to us here.

I had PTSD after a traumatic birth. I contacted PALS to request a debrief. Being able to clarify and talk about what had happened to me was the catalyst I needed to heal. I would highly recommend it if you are able to do something similar.

Speaking as an anaesthetics/ICU doctor....moving to theatre for intubation is a completely normal thing to happen when any difficulty managing a patient's airway is anticipated (for example after major facial surgery). There's more space in theatres; surgeons can be scrubbed and ready to do an immediate trachy if necessary; there's more specialist equipment available; the set up is generally much better than in a ward bed on ICU. If it only took an hour in theatre that's a reasonable sign that it all went pretty smoothly. They may have spent some time putting extra drips (in your neck/wrist) in while you were there as again it's often easier to do than once you're back in a hospital bed on the ward.

Even if your hospital has no formal follow-up service, I'm pretty sure that one of the ICU consultants or an ICU sister would be able to talk to you about roughly what happened during the time you were asleep/ why things were done the way they were. There will be more than 1 ICU consultant if you didn't bond with the one you described above. Most ICU docs are pretty approachable and most of us understand that there may well be things that patients want to understand once the acute phase of an illness is over. Alternatively, if it's specifically the time in theatre you want to know about then the anaesthetist looking after you may be able to chat (it may have been a different person to the ICU doc you referred to).

Thank you so much for the responses,both professional and personal. I feel much more reassured and wish I’d asked a long time ago. I cannot tell you how much difference it has made to me. I’ve never had a mental health problem before and this is quite alien to me. I’ve always bounced back very easily but this has been much harder.

I know I’d feel better for knowing exactly what happened but for a while, I was worried it would make me worse.

I will speak to PALS. I will find out if there’s follow up and I will talk to my husband more and get through this, day by day. It feels minute by minute sometimes but I am making teeny improvements.

”It is very common to suffer from PTSD following induced coma, only someone who's been there understands the desperate need to know what happened in the most minute detail. You are not going mad and you will recover.”

Thank you for these words. People don’t get why it’s important to know when they washed me, when I had medication, the name of the medication and who visited me that day etc. Thank you for understanding. I am quite a logical person and think it’ll be easier if I work through what happened.

I hope I can recover and get through this for the sake of my family who went through their own hell.

Thank you thank you again x