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My opinion, and I know it isn't popular, is that she is, unfortunately, permanently and irreversibly neurologically damaged to at least a PVS state, if not brain dead. I don't think she will ever recover to any significant degree, even to getting off a ventilator. Sadly, there is really very little realistic hope of any kind of recovery here, IMO.
All the commentators are being "soooooo careful" to not say anything realistic about what's going on. Sometimes I wonder if Sanjay Gupta is really even a doc-- because he does not talk like any medical specialist I have ever met. He sugar coats EVERYTHING, IMO. Maybe because of liability issues for CNN or something, or maybe just minimizing what he knows to be true, out of respect. He downplays everything serious he comments on, not just in this situation, IMO.
BK is in a devastating, dire situation. I'm sorry to be that blunt, but anyone with a serious amount of health care and ICU experience will agree. Drowning, arrest at the scene, 3 weeks of coma-- there is just nothing at all about this situation that should prompt false hope in people who are not her closest loved ones. They are devastated, and in denial, and that is completely understandable. I have great compassion for any family in that situation. But those of us much further removed from the emotion, and the exquisitely painful circumstances of her situation, can be more objective about what's going on.
I agree with Katydid's ICU friend above-- they have "brought her out of" whatever medically depressed state she has been in-- probably several times.
The specialists know exactly what her situation is right now.
It's a hard, hard truth, but sometimes people are more broken than we are able to fix.
She's breathing, according to CNN. [video=cnn;entertainment/2015/01/31/bobby-kristina-brown-found-unresponsive.cnn]http://www.cnn.com/2015/01/31/entertainment/whitney-houston-daughter-unresponsive/index.html[/video]
A previous study reported a survival rate of only 1.7% in 1,669 adult drowning patients who were in a cardiac arrest when the emergency medical services (EMS) arrived. Of these, only 0.7% survived with a favourable neurological outcome at 1-month after the near-drowning incident [2]. Despite the advances in critical and emergency care medicine, several attempts to resuscitation have proven unsuccessful in improving the outcomes of drowning and near-drowning victims [3],[4].
Results
EMS attended 336 drowning-related OHCA during the study period. Cases frequently occurred in summer (45%) and the majority of patients were male (70%) and adult (77%). EMS resuscitation was attempted on 154 (46%) patients. Of these patients, 41 (27%) survived to hospital arrival and 12 (8%) survived to hospital discharge (5 adults [6%] and 7 [12%] children). Few patients were found in a shockable rhythm (6%), with the majority presenting in asystole (79%) or pulse-less electrical activity (13%). An initial shockable rhythm was found to positively predict survival (AOR 48.70, 95% CI: 3.80624.86) while increased EMS response time (AOR 0.73, 95% CI: 0.540.98) and salt water drowning (AOR 0.69, 95% CI: 0.010.84) were found to negatively predict survival.
RESULTS:
During the study period, 66,716 OHCAs were documented, and resuscitation was attempted for 62,048 patients (1300 children [2%] and 60,748 adults [98%]). Among these OHCAs, 1737 (3% of OHCAs) were due to drowning (36 younger children [2%], 32 older children [2%], and 1669 adults [96%]). The odds of one-month survival were significantly higher for younger children (28% [10/36]; adjusted odds ratio [AOR], 20.20 [95% confidence interval {CI} 7.45-54.78]) and older children (9% [3/32]; AOR, 4.47 [95% CI 1.04-19.27]) when compared with adults (2% [28/1669]). However, younger children (6% [2/36]; AOR, 5.23 [95% CI 0.52-51.73]) and older children (3% [1/32]; AOR, 2.53 [95% CI 0.19-34.07]) did not have a higher odds of neurologically favorable outcome than adults (1% [11/1669]).
CONCLUSION:
In this large OHCA registry, children had better one-month survival rates after OHCA due to drowning compared with adults. Most survivors in all groups had unfavorable neurological outcomes.
Conclusions Drowned children in whom return of spontaneous circulation is not achieved within 30 minutes of advanced life support have an extremely poor outcome. Good neurological outcome is more likely when spontaneous circulation returns within 30 minutes of advanced life support, especially when the drowning incident occurs in winter. These findings question the therapeutic value of resuscitation beyond 30 minutes in drowned children with cardiac arrest and hypothermia.
My opinion, and I know it isn't popular, is that she is, unfortunately, permanently and irreversibly neurologically damaged to at least a PVS state, if not brain dead. I don't think she will ever recover to any significant degree, even to getting off a ventilator. Sadly, there is really very little realistic hope of any kind of recovery here, IMO.
All the commentators are being "soooooo careful" to not say anything realistic about what's going on. Sometimes I wonder if Sanjay Gupta is really even a doc-- because he does not talk like any medical specialist I have ever met. He sugar coats EVERYTHING, IMO. Maybe because of liability issues for CNN or something, or maybe just minimizing what he knows to be true, out of respect. He downplays everything serious he comments on, not just in this situation, IMO.
BK is in a devastating, dire situation. I'm sorry to be that blunt, but anyone with a serious amount of health care and ICU experience will agree. Drowning, arrest at the scene, 3 weeks of coma-- there is just nothing at all about this situation that should prompt false hope in people who are not her closest loved ones. They are devastated, and in denial, and that is completely understandable. I have great compassion for any family in that situation. But those of us much further removed from the emotion, and the exquisitely painful circumstances of her situation, can be more objective about what's going on.
I agree with Katydid's ICU friend above-- they have "brought her out of" whatever medically depressed state she has been in-- probably several times.
The specialists know exactly what her situation is right now.
It's a hard, hard truth, but sometimes people are more broken than we are able to fix.
I just want to pop in and state that I actually am quite familiar with Sanjay Gupta's background. My criticism of his celebrity doc commentary was meant to point out that he comments as though he is a just a layperson with only a "bit more" knowledge, not as a highly experienced and trained specialist. He is obviously much more highly educated and experienced than I am in the area of neurology/ neurosurgery, and I don't pretend to know more than he does. And that's exactly my point. I believe that it's his serious responsibility not to be a celebrity talking head "making nice" to every possible viewpoint, and give dumbed down soft opinions on matters of fact-- but, instead a responsibiity to provide actual, solid, science based facts that non-medically educated people can use to make realistic interpretations.
Here is just ONE reference (recent; 2012) related to the outcomes of adult drownings with cardiac arrest at the scene:
http://www.sjtrem.com/content/22/1/77
BBM. Full text article at link, not just abstract.
BTW, KZ, I agree with you that Bk probably didnt have an infection. I was speculating that based on several news reports that her trach was an emergency procedure.
In all likelihood, I agree it was a planned procedure where she also got a g tube in preparation of her leaving the ICU for another destination.
I hope I didn't imply that she doesn't have an infection-- it's highly likely she does have several sources of infection, as well as more than possible that she has ARDS. (Adult respiratory distress syndrome.) Either way, the trach was indicated, and there's no indication it was any kind of emergency procedure.
http://en.wikipedia.org/wiki/Acute_respiratory_distress_syndrome
http://www.ncbi.nlm.nih.gov/pubmed/907076