Brief Answer:
I would be more than happy to help you

Detailed Answer:
Hello XXXXXXX and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that I am here to help. I am sorry to hear about the patient if at all this has occurred in reality, but if it is just a scenario presented then it is indeed a well detailed one. I would be more than happy to help you.

1. From my experience, the average duration of keeping an individual sedated mainly to be able to keep him/her on artificial ventilation (intubated) is about 14 days (2 weeks). But, the main complications experienced by keeping an individual for a duration longer than this is not usually associated with the nervous system. Reason being, that the intubation is helping with excellent delivery of oxygen to the brain which prevents nervous system damage of any sort.

The more common complications seen are: poor functioning of the gastric system, deep vein thrombosis (DVT), stress ulcers or bed sores, respiratory disorders associated with the ventilation, etc.

2. Some individuals just respond poorly to weaning off from the mechanical ventilation, this could either be just poor recovery or possibly even brain damage due to poor delivery of oxygen to the brain.

As a tracheotomy was performed, this was most probably because the patient was not able to adequately breath himself. The cause for this would have either been a head injury, spine injury, or possible obstruction of the airways.

With either of those causes, the breathing would have temporarily been either obstructed or difficult. The main harm this kind of a scenario can cause is reduced oxygen delivery to the brain, which sadly can result in brain damage. Please check with the patients doctors, if this was the case. If at all it was then the cause for the poor recovery and difficulty in weaning of mechanical ventilation.

I hope you find my response helpful helpful and informative. Please feel free to write back to me for any further clarifications, I would be more than happy to help you.

Best wishes.

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Brief Answer:
My apologies for not addressing that query

Detailed Answer:
Hello once again sir.

Yes, prolonged sedation is indeed harmful and the duration would be the same (about 2 weeks), average time without causing damage to the nervous system. But waiting for that long would not be advisable and weaning should be started much earlier. As has been attempted once already.

It all comes down to whether or not we choose between slight cognitive impairment and quality of life itself. It becomes a bargain in which we continue to keep the patient on sedstion because it helps to keep him alive by delivering oxygen to his brain. If this is the case, then we have no choice but to choose his life over possible cognitive impairment.

No sir, we do not need to keep him sedated and on mechanical ventilation for the duration of healing of the ribs. But simply just as long as he has difficulty in breathing himself and if self respiration is not helping with delivery of sufficient amount of oxygen to the brain; only until these factors are present will we have to keep him sedated.

I hope my response helps clear your queries XXXXXXX My apologies for not addressing your first query adequately in my last response. Please do not hesitate to write back to me for any further clarifications, I am always here to help.

Best wishes.

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