Let me start this by saying Tom is stable. Many things are continuing to improve but Tom's mental status and respiratory status are still problematic. They had to up the amount of Propofol that Tom was getting after I left last night. Early this am he became extremely agitated and they had to give him Versed (another sedative) because his respiratory rate went up to 48 and he couldn't be calmed. They are terming Tom's condition at this point as ICU syndrome or ICU psychosis. (I am choosing to use "syndrome" because I think it sounds nicer.) I will give you a brief rundown of what this is and then let you know the new plan of action.
So, ICU syndrome is a very common situation seen in patients who have been in the ICU for an extended period of time. Many factors play into causing a patient to have ICU syndrome both environmental and medical. Tom of course has multiple factors from each category.
On the environmental side of things, he is probably suffering from severe sleep deprivation. Even though he has been sedated for a long time his sleep pattern is continually interrupted due to assessments, changing his position, beeping of monitors and IV pumps, tests, visitors, ect. His mind and body have both been severely stressed due to his illness.
On the medical side, infection, medications, electrolyte imbalances, as well as just being critically ill can all cause symptoms of ICU syndrome.
Symptoms of ICU syndrome are all things we have seen in Tom: fluctuating levels of conciousness, aggressive behavior, agitation, disorientation and the like.
The good news is it will resolve, the bad news is that in order to help him they will need to put him on more meds and keep him sedated while these new meds have a chance to get in his system and do their job. So, no extubation in the next few days. He also still has some electrolytes that are out of whack so they are still working on resolving that. The long road just got a bit longer...
But just so you all know our Tom is in there, I saw him yesterday. He even lifted his head and closed his lips when I asked him for a kiss. He'll be back to us, it's just a matter of time. Thanks for all the love for Tom, me, and our entire family!