Bobbi Kristina Being Weaned Out of Medically Induced Coma-UPDATE

More than three weeks after  Bobbi Kristina Brown was found unresponsive in the bathtub of her Roswell, Georgia home, physicians have begun to wean the 21-year-old daughter of Whitney Houston and Bobby Brown out of her medically induced coma.

Bobbi Kristina’s condition remains serious and she remains on life support. On February 19, she underwent a tracheotomy to have a breathing tube placed into her lungs. This is frequently done in patients who have had a breathing tube for a prolonged period of time and is done to decrease the risk of infection.

Family members including her father, and grandmother Cissy Houston, have maintained a vigil by Bobbi Kristina’s bedside. A family source told PEOPLE magazine:

“There will be a sign of hope, and then nothing. Every day, we wonder if this will be the day that we get good news….We’re all hoping and praying that this [taking Bobbi Kristina off the medications] will give us some answers.”

The cause of Bobbi Kristina’s current condition is still under investigation. Some reports claim that she had regularly taken heroin, cocaine and xanax in the months before she was found unconscious. Her boyfriend, Nick Gordon, has been questioned in the matter, as well as a houseguest, Max Lomas who reportedly found Bobbi in the bathtub.

In an ironic twist of fate, Bobbi Kristina’ s mother Whitney Houston died in her bathroom almost exactly three years earlier. The Los Angeles County coroner’s report (Case Number 2012-01022) listed heart disease as a contributing factor and also noted that the singer had cocaine, marijuana, Xanax, Flexeril and Benadryl in her system as well.

UPDATE 2/26/2014

The attempt to wean Bobbi Kristina out of a medically induced coma was stopped when she began to have seizures. PEOPLE is reporting:

“She was taken off the drugs, but she began having voilent seizures. She is being put back into a coma.”

What is a tracheotomy?

A tracheostomy is a surgically made hole that goes through the front of your neck and into your trachea, or windpipe. The hole is made to help you breathe.

A tracheostomy usually is temporary, although you can have one long term or even permanently. How long you have a tracheostomy depends on the condition that required you to get it and your overall health.

Overview

nasal_airway_surgeryTo understand how a tracheostomy works, it helps to understand how your airways work. The airways carry oxygen-rich air to your lungs. They also carry carbon dioxide, a waste gas, out of your lungs.

The airways include your:

  • Nose and linked air passages (called nasal cavities)
  • Mouth
  • Larynx, or voice box
  • Trachea, or windpipe
  • Tubes called bronchial tubes or bronchi, and their branches

Air enters your body through your nose or mouth. The air travels through your voice box and down your windpipe. The windpipe splits into two bronchi that enter your lungs.

sean-kelley-tracheotomyA tracheostomy provides another way for oxygen-rich air to reach your lungs, besides going through your nose or mouth. A breathing tube, also called a trach (trake) tube, is put through the tracheostomy and directly into the windpipe to help you breathe.

Doctors use tracheostomies for many reasons. One common reason is to help people who need to be on ventilators  for more than a couple of weeks.

Ventilators are machines that support breathing. If you have a tracheostomy, the trach tube connects to the ventilator.

People who have conditions that interfere with coughing or block the upper airways also may need tracheostomies. Coughing is a natural reflex that protects the lungs. It helps clear mucus (a slimy substance) and bacteria from the airways. A trach tube can be used to help remove, or suction, mucus from the airways.

Doctors also might recommend tracheostomies for people who have swallowing problems due to strokes or other conditions.

Outlook

Creating a tracheostomy is a fairly common, simple procedure. It’s one of the most common procedures for critical care patients in hospitals.

The windpipe is located almost directly under the skin of the neck. So, a surgeon often can create a tracheostomy quickly and easily.

The procedure usually is done in a hospital operating room. However, it also can be safely done at a patient’s bedside. Less often, a doctor or emergency medical technician may do the procedure in a life-threatening situation, such as at the scene of an accident or other emergency.

As with any surgery, complications can occur, such as bleeding, infection, and other serious problems. The risks often can be reduced with proper care and handling of the tracheostomy and the tubes and other related supplies.

Some people continue to need tracheostomies even after they leave the hospital. Hospital staff will teach patients and their families or caregivers how to properly care for their tracheostomies at home.

What is a medically induced coma?

A medically induced coma is when a patient receives a controlled dose of an anesthetic to cause a temporary coma or a deep state of unconsciousness. The objective is to give enough medication to significantly slow brain wave activity. Drugs used include pentobarbital, thiopental, or the drug of Michael Jackson fame, propofol.

This type of coma is typically used to protect the brain from swelling. The brain swelling may be caused by injury (such as was the case for Gabby Giffords) or after brain surgery. Being in a coma reduces the blood flow through the brain as well as metabolic rate of brain tissue.

When in a medically induced coma, a patient’s vital signs must be constantly monitored by an anesthesiologist or other physician. Patients are usually intubated and ventilated (this means that a tube is placed in the windpipe and a machine breathes for you). This is done only in a critical care setting.

Subhashini Ramesh, a professor of NeuroCritical Care at Georgia Regents University who is not involved in Bobbi Kristina’s case, explained to PEOPLE.  a patient may be “weaned off a medically induced coma for two reasons – because the underlying problem has improved, or to simply get a sense of what the patient is able to do for themselves.”

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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