My name is Patrik Hutzel from intensivecarehotline.com, 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 the best care and treatment, even if you’re not a doctor or a nurse in intensive care.

So today I have a question from one of our readers, Binosh, who says:

“Hi Patrik, 

After being desperate to find info about tracheostomy, I found your YouTube videos. My father is 93 years of age, with no underlying condition except Alzheimer’s and difficulty speaking. Following COVID-19 in October this year, he got really unwell. He has been spending the last 24 nights and days in the ICU on a ventilator. We’re getting conflicting information. One says lungs have no hope, and he will pass away in the next 24 hours. 

Then we can see ICU stabilizing him with blood pressure medication and giving him blood transfusions. The ICU team offered a tracheostomy after two weeks, but our family refused initially as we didn’t want a hole in his neck. Now, after 24 nights in the ICU, we are okay with him having a tracheostomy. My question is, what is the right decision, weaning off from the ventilator and letting him die naturally? We really appreciate your advice.”

From, Binosh

So Binosh, thank you so much for your question about your 93-year-old father who’s been on a ventilator for 24 days in ICU following COVID-19. Binosh, this is an incredibly difficult situation, make no mistake, and I can hear the confusion and distress that you and your family are experiencing with the conflicting information you’re getting from the ICU team. But let me break this down for you.

First of all, your father has been on the ventilator for 24 days now, which is significant. The fact that the ICU team initially offered a tracheostomy after two weeks shows that they recognized he wasn’t going to come off the ventilator quickly. Now that 24 days have passed, the situation has become more urgent because prolonged intubation can cause complications like tracheal damage, ventilator-associated pneumonia, and difficulty in weaning.

The conflicting information you’re receiving is unfortunately common in the ICU. One doctor says no hope, 24 hours to live, yet the nurses are stabilizing him with blood transfusions and blood pressure support. This tells me that your father is critically ill, but the medical team and the ICU team haven’t given up on him, otherwise they wouldn’t be providing these interventions. You also need to question their clinical judgment if they’re telling you he only has 24 hours to live and now he’s been alive for 24 days.

So, the odds are probably in your dad’s favour to survive, but survival might not be the only thing that is important here, and I’ll come to that in a minute. But you have to watch what’s being said and what is actually happening. If they’re telling you, “Oh, your dad won’t survive another 24 hours,” and he’s now lived 24 days, you really have to question their clinical judgment. You also have to keep in mind that 70 to 90 percent of ICU patients survive, so the odds are actually in your dad’s favour for survival.

So, let’s look at what you need to know about tracheostomy versus prolonged intubation. Tracheostomy is not necessarily a permanent decision, and it’s often the pathway to getting your father off the ventilator, not keeping him on it forever. Let me explain the benefits of a tracheostomy in your father’s situation.

Number one, increased comfort. A tracheostomy is far more comfortable than having a breathing tube through the mouth for weeks. Your father would be able to move his head, potentially communicate better even with Alzheimer’s, and could even start potentially eating and drinking with proper assessment and support.

Number two, better weaning opportunities. Paradoxically, a tracheostomy often makes it easier to wean from the ventilator because it reduces the work of breathing, allows for better secretion management and enables progressive weaning trials without the trauma of repeated extubations and reintubations.

Number three, reduced complications. After 24 days on an endotracheal or a breathing tube in the mouth, your father is at very high risk for tracheal damage, vocal cord injury, and ventilator-associated pneumonia. A tracheostomy can actually reduce some of those risks.

Number four, sedation and opiates can be discontinued straight away. Your dad at the moment would be on a certain level of opiates and sedation, which causes deconditioning, muscle wastage, and just lethargy in general. So, your dad needs to come off the sedatives and the opiates as quickly as possible, and therefore, a tracheostomy would also help, assuming he can’t come off the ventilator with a breathing tube.

Number five, mobility and rehabilitation. With a tracheostomy, your father could potentially sit up in bed, get out of bed, participate in physical therapy, and begin rehabilitation much sooner, all of which will improve outcomes.

Now, Binosh, let’s also look at the reality of the situation. Your father is 93 years old, has Alzheimer’s disease, has been critically ill with COVID-19, and has been on a ventilator for 24 days in the ICU with a variable GCS (Glasgow Coma Scale) score of 4 to 7, which indicates significant neurological impairment. This is a very serious situation.

The question isn’t just tracheostomy, yes or no. The question is, what are the realistic goals of care for your father, and what does success look like? You need to consider and understand that number one, can he realistically be weaned from the ventilator with a tracheostomy, or will he remain ventilator dependent? Two, if he can be weaned, what will his quality of life be like, given his age and Alzheimer’s disease? Number three, if he can’t be weaned, is long-term ventilation at home an option for your family, or would he need to remain in the ICU? And number four, what would your father have wanted if he could speak for himself?

Now, also, it’s critically important at this particular point in time we know that you get access to all medical records,  and you have a second opinion and expert review. Because you need access to all of your father’s medical records ASAP, admission notes, daily progress notes, ventilator settings, blood gas results, chest x-rays, CT scans, microbiology results, nursing notes, doctor’s notes, the works, everything you need to leave no stone unturned.

Without us reviewing these records, it’s impossible for me to give you specific guidance on whether a tracheostomy is the right decision. The devil is in the details when you have a family member in intensive care. And the minute you skip steps, the minute you are not doing the research, the minute you’re not getting a second opinion, you are fighting an uphill battle, and the ICU team will retain the upper hand, and you can’t really afford that.

This is exactly where a consulting call with me or the intensivecarehotline.com team becomes invaluable. We can review your dad’s medical records in detail, understand the full clinical picture, and then have a conference call with you and the ICU team. During this call, we can ask all the critical questions that need to be asked, clarify the conflicting information you and your family have been receiving, advocate for your father’s best interest, help you understand the realistic prognosis, explore all available options, and support you in making informed decisions.

We’ve done these hundreds, if not thousands of times, for families all around the world in intensive care, including in countries where the medical system and cultural approaches to end of life  care can be not patient and family centric. And we’ve gotten results for many of our clients, for all of them, and we’ve helped save so many lives in the ICU with our consulting and advocacy.

So, here are your options moving forward. Option one: proceed with a tracheostomy. If the ICU team believes your father has a reasonable chance of improving with a tracheostomy, and if your family wants to give him every opportunity to recover, then proceeding with a tracheostomy might be appropriate. This gives him the best chance of coming off the ventilator eventually, surviving his critical illness, and returning to some level of baseline function.

Number two, let’s also consider some long-term ventilation options. If your father can’t be weaned from the ventilator, even with a tracheostomy, you need to know that there are long-term options. This is where intensivecareathome.com becomes relevant. We help families in intensive care transition their loved ones from ICU to home with long-term ventilation and tracheostomy care.

Intensive Care at Home can be a game changer because it allows you to keep your father out of ICU predictably and permanently, provide him with 24 hour intensive care nurses in the comfort of his own home, maintain his dignity and quality of life, avoid complications such as infections associated with prolonged ICU stays, be involved in his daily care as family and not as caregivers.

Even if your father does require long-term ventilation with tracheostomy or potentially non-invasive ventilation without a tracheostomy or if the decision shifts towards palliative care, Intensive Care at Home provides a compassionate alternative to keeping your dad in ICU indefinitely or transferring him to a long-term facility, which you don’t want in the first place. You don’t want him to stay in the ICU indefinitely. You don’t want him to move to a long-term facility.

Then next, focus on comfort and palliation. Given your father’s age, underlying Alzheimer’s disease, and the severity of his COVID-19 illness, it’s also appropriate to consider whether aggressive treatment is in his best interest or whether focusing on comfort and dignity might be more appropriate. I understand this is complicated by the fact that weaning from the ventilator to let him die naturally, maybe even illegal, which adds another layer of complexity to your decision-making. Letting someone die without offering treatment is illegal in most countries.

So, what should you do right now? Here’s my advice for your immediate next steps. Number one, request a family meeting with the ICU team and have me present. Ask for a formal meeting where all specialists involved in your father’s care can sit down with your family and provide a unified assessment and prognosis. Ask them specifically, what is his realistic chance of surviving to ICU discharge? If he survives, what will his functional status likely be? Can he realistically be weaned from the ventilator with a tracheostomy? What is the time frame they’re expecting? What are the alternatives if he can’t be weaned?

Get access to all medical records. Request complete copies of all medical records. You have a right to this information, and it’s essential for understanding the full picture.

Let’s schedule a consulting call with me at intensivecarehotline.com. We review medical records, clarify the medical information, and participate in a family meeting or conference call with the ICU team if needed. We can question, advocate, and help you navigate this almost impossible decision.

Next, consider your father’s wishes. What would your father have wanted? Would he have wanted aggressive treatment at 93 years of age with Alzheimer’s disease, or would he have preferred comfort and dignity? This should guide your decision-making.

Next, do not rush, but also don’t delay. 24 days on a ventilator is significant, and prolonged intubation carries a high risk, as discussed. However, you also shouldn’t be pressured into a decision without fully understanding all the implications. Get the information you need but recognize that time is a factor.

Here’s the bottom line. There is no universal right decision here. The right decision is the one that honors your father’s wishes, values, and best interests while being realistic about his situation. A tracheostomy is not a death sentence. It’s often a pathway to recovery and liberation from the ventilator, but it’s also not a guarantee of survival or quality of life, especially at your dad’s age with multiple comorbidities and severe COVID-19.

What I can tell you is this, you don’t have to navigate this alone. The conflicting information, the medical complexity, and the legal considerations, all of this can be addressed with proper support, expert guidance, and advocacy, and that’s exactly what we do at intensivecarehotline.com. We help families like yours every single day, anywhere in the world, to understand their options, question the ICU team appropriately, and help you to make informed decisions, have peace of mind, control, power, and influence.

If your father does survive but requires long-term ventilation or tracheostomy care at home, or needs palliative care at home, Intensive Care at Home can help you create a care plan that keeps him out of ICU permanently, predictably, and allows him to be cared for with dignity in a family friendly and patient-friendly environment, whether that’s for ongoing treatment or for palliative care, comfort for now.

Don’t wait until it’s too late. Contact us today at intensivecarehotline.com.

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.

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.

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.  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.