Stopping the sedation!

Let’s be unambiguous about this – the announcement that Michael’s care team is discontinuing his sedation is the news we’ve been waiting for. It’s the first big transition – from acute, life-threatening head injury to subacute recovery. Followed no doubt, let’s not forget, by a chronic rehabilitation phase. But this is wonderful news.

In terms of how this is done, well it’s actually pretty simple. The electronic pumps driving the continuous infusions of the sedative drugs are turned off. That’s it. But doing that means that the people taking care of Michael have a reasonable expectation that he will not exhibit untoward reactions to the “stress” of these medicines being turned off. The most undesirable of these would be elevations in . . . you guessed it . . . intracranial pressure, but to be honest, we’re now more than four weeks post-injury, and I’d rather think that we’re past that.

So what will happen now that this stuff is turned off?

1) It may or may not be true that, in general, French neurointensivists maintain sedation longer than their Anglo-Saxon colleagues. It doesn’t matter. The people taking care of Michael know what they’re doing.

2) while it’s possible that a long-acting drug may well have been used in the early, “suppressive” phase of Michael’s care, it’s quite likely that if so, it’s been replaced with one or more short-acting substances. These usually allow signs of emergence to appear within several hours of stopping the infusions.

3) What actually happens? Well in general, the first attempt to stop sedation usually gets interrupted by something. The patient gets agitated, the blood pressure goes up, the oxygen saturation goes down . . . something. So you turn the sedation back on, let the situation settle down, and then either try again or wait until tomorrow. It often takes a few tries before everything goes the way it should.

How should it go? Well ideally Michael will start to want to breathe, and allow weaning from ventilatory support. And just as important of course he will hopefully start to show meaningful interaction with his environment. Following simple commands, visual tracking, etc.

Now I’ve heard (from unconfirmed sources), unconfirmed reports (double “unconfirmed” should ring alarm bells of course) that Michael has indeed already done this.

I’d love any neurosurgeons to jump in and comment, but if this indeed is true, it is fairly astonishingly good (but indeed totally conceivable) news. So we need to cross our fingers and hope something like this DOES get confirmed in the future.

Tell you what – let’s not talk about any other alternatives right now, ok, so we keep it positive.

One last thing.

I’ve seen some very heartfelt comments here and there about articles, tv pieces, and blog speculation “hurting” Michael’s family. I wanted to just weigh in for a second.

I’ve been pretty harsh with the tabloid press, and deservedly so. But not because the Daily Mail’s moronity hurts Corinna, Gina Maria and Mick. ARE YOU KIDDING? Could they possibly hurt more? And if so, is it likely to be because of the suffering induced by a British rag? Of course not. I think it’s detestable coz it’s shit “journalism”. I kinda don’t think it’s on Corinna’s reading list, I don’t think their “journalism” could possibly add to their pain, and lastly, Michael’s care team have no doubt been TOTALLY up front with the family. Meaning they have a better idea than any of us of just what the . . . hell . . . is up.

If I thought for a second that anything I’ve written might hurt Michael or his family, I’d not have written it. To be honest, I’ve spoken to you as I’d speak to Michael’s family. I assume you know that, because I think it’s to THAT that you’ve reacted (to my infinite astonishment), more than to the information that I’ve transmitted.