My name is Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care, where we instantly improve the lives for families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power and influence, making sure your loved one always gets best care and treatment, even if you’re not a doctor or a nurse in intensive care.

Today, I have an email from Maria who says:

Hi Patrik, 

My mom is in the ICU. She’s on dialysis. They’re saying one-way extubation or tracheostomy and PEG, and then straight to LTAC. I want to try to extubate with BiPAP assistance because she does have COPD and CHF. They’re pushing us hard to get us out of here. 

From Maria.

Just in case you’re wondering what CHF stands for, it stands for chronic heart failure. 

Let’s look at how we can help Maria here to improve her mom’s situation.

I’m very sorry, Maria, to hear what you’re going through with your mom in ICU. The pressure you’re feeling from the ICU team to make quick decisions about tracheostomy, PEG (Percutaneous Endoscopic Gastrostomy) tube, and LTAC (Long Term Acute Care) transfer is exactly what hundreds, if not thousands, of families contact us about every single week, and have been for many, many years — as a matter of fact, since 2013.

For those of you who are wondering what an LTAC is, it stands for Long-Term Acute Care Hospital. It is specific to the United States of America. LTACs only exist in America. LTACs are not good places for ICU patients, and I’ll come to that a little bit later. Let me be very direct with you: LTAC facilities are not the right choice for ICU patients with COPD (Chronic Obstructive Pulmonary Disease)  and chronic heart failure, especially when extubation with BiPAP (Bilevel Positive Airway Pressure) support hasn’t been properly attempted yet.

Your instincts about trying BiPAP extubation first are absolutely correct. Patients with COPD — which stands for Chronic Obstructive Pulmonary Disease — and CHF, Congestive Heart Failure or Chronic Heart Failure, often respond extremely well to BiPAP after extubation. This is actually evidence-based medicine.

The ICU pushing for one-way extubation — meaning extubation to comfort care only — or immediate tracheostomy and PEG with LTAC transfer tells me they may not be considering all treatment options for your mom.

Treatment options they should be considering, and what should be discussed before any tracheostomy or LTAC transfer  is being discussed:

Number one, trial extubation with BiPAP. Many COPD and Congestive Heart Failure patients are successfully extubated to non-invasive ventilation. BiPAP can support breathing while avoiding reintubation. This gives your mom a chance to recover without a tracheostomy.

Next, medical management needs to be optimized first. Diuresis for Congestive Heart Failure — fluid removal through dialysis or medications such as Lasix, furosemide, or spironolactone. Bronchodilators and steroids for COPD exacerbation. Continue dialysis to remove fluid overload. Treat any underlying infections.

Next, physical therapy and mobilization. Early mobility, even when on ventilation. Respiratory therapy for secretion management. Speech therapy assessment for swallowing. Physical therapy working towards extubation.

Next, proper weaning protocols. Spontaneous breathing trials. Assessment of respiratory muscle strength. Evaluation of consciousness and airway protection. Physical therapy, movement, and mobilization are critical — assuming there are no contraindications to mobilization. A breathing tube in and of itself is not a contraindication. Contraindications would be hemodynamic instability, bleeding, awaiting surgery, and the list goes on.

Now, why is there such a rush to go to LTAC?

The ICU is pushing hard to transfer your mom to LTAC because they need the bed in ICU for another patient. There might be insurance pressure and length of stay targets. There might be financial pressures and targets. They’ve made up their mind about the outcome. LTAC seems like the easy solution and offers an out-of-sight, out-of-mind solution. But LTAC is definitely not the answer.

Let’s look at the reality of LTAC facilities. LTAC stands for Long-Term Acute Care. Facilities in the US often have less or no monitoring compared to ICU, fewer registered nurses — let alone critical care trained nurses — less or no access to specialist doctors, much higher infection rates, and lower success rates for ventilator weaning. I encourage you to look up online reviews for LTAC facilities. It’ll probably boggle your mind.

The good news is we’ve helped hundreds of families avoid LTAC transfers by advocating for their loved ones to stay in ICU successfully, and for much longer than the ICU wanted them to stay, where proper treatment, proper weaning protocols, and specialist care will give your loved one the best chance of recovery. Our track record is documented on our testimonial section at intensivecarehotline.com, and it’s documented on our intensivecarehotline.com podcast, where we’ve done interviews with clients.

Maria, this is exactly the situation where my consulting service at intensivecarehotline.com has literally saved hundreds, if not more, lives. Here’s what we do: 

We look at the medical records. We need complete access to all medical records, including daily progress notes, doctors’ and nurses’ notes, ventilator settings and weaning parameters, lab results and trend analysis, imaging reports — chest X-rays, CT (Computed Tomography) scans, MRI (Magnetic Resonance Imaging) scans — dialysis records, medication lists, and all notes from all specialists, nurses, and physios. We leave no stone unturned.

Next, you and I get on a consulting call with the ICU team where we ask questions about their reasoning for refusing a BiPAP trial, advocate for alternative treatment options, clarify the actual medical situation versus what you’re being told, challenge the rush to tracheostomy, and LTAC.  Demand that a proper weaning protocol be attempted.

We bring evidence-based advocacy. With my experience — I’ve worked in critical care nursing for over 25 years in three different countries, where I also worked as a nurse manager in intensive care for over five years — I have knowledge of current medical evidence and treatment in ICU, experience with hundreds of similar cases, and understanding of what’s medically possible versus what’s merely convenient for the ICU.

Check out our testimonial section at intensivecarehotline.com or listen to our intensivecarehotline.com podcast where we’ve done client interviews. You can access the podcast on our website, intensivecarehotline.com.  We’ve helped hundreds of families keep their loved ones in the ICU instead of being rushed to LTAC, and many times our advocacy has saved many lives in the ICU.

Let’s look at the worst-case scenario as well. What if your mom does need long-term ventilation? If it turns out your mom genuinely needs prolonged ventilation support  — invasive or non-invasive — or can’t be weaned and requires a tracheostomy, there’s a much better option than LTAC: Intensive Care at Home at intensivecareathome.com, where you can learn about keeping your mom out of ICU predictably and permanently, at home, with proper evidence-based ventilation care — invasive or non-invasive — with 24-hour critical care trained nurses, with tracheostomy management if needed, and even palliative care with dignity and comfort if needed.

Home ventilation with Intensive Care at Home is evidence-based, often safer, more comfortable, more holistic, more family friendly, and provides better quality of life than ICU and LTAC facilities — and it costs 50% of an ICU bed, while freeing up the most sought-after bed in a hospital: the ICU bed.

Maria, here’s what you need to do right now. Contact us immediately at intensivecarehotline.com. Request a family meeting with the ICU team. Demand all treatment options be discussed. Ask specifically about a BiPAP extubation trial. Request access to medical records. Request their medical reasoning in writing. And you and I get on a consulting call with the ICU team.

Don’t be pressured. You have the right to question and advocate. Second opinions are appropriate. LTAC is not an option, and the pressure they’re putting on you is just perceived — change your perception and you won’t feel the pressure.

The bottom line is your mom has COPD and Congestive Heart Failure. These are conditions that often respond well to non-invasive ventilation after extubation. The ICU pushing for immediate tracheostomy, PEG and LTAC transfer without attempting BiPAP extubation first is not following best medical evidence and practice.

You need expert advocacy right now. Do not delay. Take action now and schedule a consulting call with me, because your instincts about trying BiPAP first are correct. You deserve answers, you deserve options, and your mom deserves the best chance at life.

I have worked in critical care nursing for 25 years in three different countries where I worked as a nurse manager for over five years in intensive care. And I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. And I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section  at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section, where we have done client interviews.  And because our advice is absolutely life-changing, right?

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for, they don’t know what questions to ask, they don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. And that’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always. And that’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives.

And that’s why I do one on one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. And I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. And when I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.  I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care, so, if, in case you have unanswered questions, if you need closure or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com. If you click on the membership link or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all questions intensive care-related. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. And all of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

And all of that you get at intensivecarehotline.com. Call us on one of the numbers at the top of our website or simply send us an email to support at intensivecarehotline.com with your questions.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.