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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

Today, I want to answer a question from one of our members that we worked with over the last few months. She is part of our membership for families of critically ill patients. You can find more information about our membership for families in intensive care at intensivecaresupport.org if you want to become a member.

So, here’s the question, “Our member says the doctors have decided that they want to do a tracheostomy, myself and my husband are in agreeance with that. They are preparing him for the procedure as we speak. Normally, how does a tracheostomy procedure work? The doctor also stated he will leave the nasogastric tube as it is.”

So, here is our answer. A tracheostomy is carried out for patients who can’t be weaned and can’t be extubated from the endotracheal tube for about 14 days. That’s sort of the research, and the evidence-based treatment that after about 10 to 14 days, you should be doing a tracheostomy if someone has shown they can’t be weaned off a ventilator and a breathing tube.

A tracheostomy similar to a breathing tube is done to deliver oxygen to the lungs if the patient is unable to breathe. Normally, due to some causes like weak respiratory muscles, injury, airway issues, obstructions, cancer, tumors, vocal cord paralysis, tracheal stenosis, and other medical conditions, a tracheostomy should be performed as soon as the need for prolonged airway support is determined or recognized.

Patients with respiratory failure, who cannot be weaned or removed from the ventilator are advised for tracheostomy patients who are on a prolonged period of time on the ventilator. Patients who are not strong enough or awake enough to cough up their secretions are also advised for a tracheostomy to avoid further complications like aspiration pneumonia, lung collapse, and many others.

So then, a tracheostomy can be done percutaneously, that means it’s done in ICU by ICU consultants. It’s basically a patient has a general anesthetic, gets chemically paralyzed with medications. Basically, the intensive is poking a hole into the trachea, a sort of dilatation, until the tracheostomy is inserted.

There’s another way to insert a tracheostomy which is surgical. Usually, an ENT (Ear Nose Throat) surgeon is performing a surgical procedure with a clear cut in the operating theater or in the operating room.

Now, that’s pretty much how this is done. Both procedures are done reasonably quickly. I’ve seen it sort of within half an hour, 45 minutes at the most. Often goes hand in hand with a bronchoscopy, which is basically putting video camera down someone’s trachea as well and have a look into the lungs, and also sometimes clear secretions.

Now, in regard to the nasogastric tube, you will find that, especially for clients in the U.S. or patients in the U.S., ICUs often want to do a tracheostomy and a PEG (Percutaneous Endoscopic Gastrostomy) tube and remove the nasogastric tube.

Now, that from our experience is not evidence-based. In other countries, a PEG tube insertion doesn’t go hand in hand with the tracheostomy. I’ve looked after patients in ICU with a nasogastric tube for six months in the U.S., specifically. The PEG tube often leads to a discharge to LTAC.

LTAC stands for Long-Term Acute Care Facility.  It’s not even the better version of a nursing home. Many patients go from ICU with a tracheostomy and a PEG tube to LTAC. Then, we have families coming, begging us to help them to get their loved ones out of LTAC because the standards of care are so low, and many, many patients often bounce back into ICU within 24 to 48 hours because LTACs are not equipped to look after critically ill patients.  It’s just designed to save money, it’s not designed for a clinical need and, patients’ conditions often deteriorate there.

There are no clear pathways to wean patients off ventilation. ICUs need beds, which is why they’re pushing people out to LTAC in the U.S., in particular. Doesn’t happen so much in other countries like the U.K. or Australia or New Zealand because there are no LTACs. Thank God for that.

But either way, a nasogastric tube is fine because a PEG tube has the perception of a permanency, and it has the perception that the person with the PEG tube will never eat or drink again and no one will even bother to try. Whereas with the nasogastric tube, it has the perception of a temporary measure. Therefore, people will try and get patients to eat and drink again, which should be the goal.

So, I hope that helps and that explains the procedure and worst-case scenario, let’s just say someone can’t be weaned off the ventilator and can’t be weaned off the tracheostomy, then you should look at services like Intensive Care at Home. So, go and have a look at intensivecareathome.com. There, we provide a service for our patients and families in intensive care, but as well as for intensive care where we help them to empty the ICU beds. But more importantly for patients and families improve the quality of life by going home.

We cut the cost of an ICU bed by around 50%. Nobody wants to be in ICU long-term and it’s a win-win situation for everyone with Intensive Care at Home. We are currently operating all around Australia. We are NDIS (National Disability Insurance Scheme) TAC (Transport Accident Commission), iCare, DVA (Department of Veteran Affairs), NIISQ (National Injury Insurance Scheme in Queensland) funded, and you can reach out to us, and we can help you with taking your loved one home.

If you are in the U.S. and you’re wondering about Intensive Care at Home, please contact us as well. We think we can point you in the right direction, potentially with some other providers. So, I hope that helps.

Now, if you have a loved one in intensive care and you want to be a member as part of our membership for families of critically ill patients, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

We can also send you a link to our membership which you can find at intensivecaresupport.org. There, you have access to me and my team, 24 hours a day, in a membership area and via emails and we answer all questions, intensive care and Intensive Care at Home related.

I also offer one-on-one consulting and advocacy for families in intensive care. I talk to doctors and nurses directly and I ask all the questions you haven’t even considered asking. But if you don’t ask them, you will fight an uphill battle.

I also represent you in family meetings with intensive care teams, once again, making sure you and your family get the best care and treatment for your loved one in ICU because I know what to look for and I know what to advocate for after having worked in intensive care for over 20 years in three different countries where I also worked as a nurse unit manager in intensive care for over five years. We’ve been consulting and advocating for families in intensive care all around the world successfully for the last 10 years. Have a look at our testimonies.

We also offer medical record reviews in real time, and we offer a saving opinion in real time. So, contact us for that as well. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

Now, if you like my videos, subscribe to my YouTube channel, click the like button, click the notification bell, comment below what you want to see next or what questions and insights you have from this video.

Thank you so much for watching.

This is Patrik from intensivecarehotline.com and I’ll talk to you in a few days.