My name is Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives of 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.

Today I want to answer a question from Georgia, who has her 41-year-old sister in the ICU for over 30 days, and we’re going to look into that in detail.

Why am I able to answer questions like this? I have worked in critical care nursing for over 25 years in three different countries, where I worked as a nurse manager for over five years, and I have been consulting and advocating for families in intensive care all around the world since 2013 here at intensivecarehotline.com. I’m also the founder and managing director of intensivecareathome.com, and here myself and my team help ICU families understand what’s happening and advocate for their loved ones in some of the most complex and frightening situations imaginable.

Today I’m responding to a real question from Georgia, whose sister is in the ICU on a ventilator for more than 30 days. Here is what Georgia writes:

“Hi Patrik,

My sister is currently in the ICU at an acute care hospital. She has been on a ventilator for over 30 days. The medical team keeps scheduling a tracheostomy but has still not performed the procedure. It all started when she developed cellulitis on her left leg, which led to her being placed on a ventilator, and she has been unable to come off it since, she has multiple underlying conditions including type 2 diabetes, COPD, kidney failure, left arm paralysis, and a blood infection, sepsis. She’s a 41-year-old female weighing 365 pounds.

Due to her weight, the team has said they are unable to perform a Magnetic Resonance Imaging (MRI) scan. They have also told us they cannot transfer her to another facility at this time, and that once the tracheostomy is completed, the plan is to move her to an acute rehabilitation facility. I’m feeling overwhelmed and unsure of what steps to take next.

What do I do? 

From Georgia”

If you are in a similar situation, or if someone you love is in the ICU on long-term ventilation, this video and blog post is for you. I’m going to cover everything from what’s happening medically, to treatment options, to what happens if she can’t come off the ventilator Georgia, this one is for you specifically — you are doing the right thing by asking questions.

What Is Happening to Georgia’s Sister Right Now

Let me explain what’s happening medically so you can understand the situation and advocate more effectively.

It all started with cellulitis, a bacterial skin infection on her left leg. In a 41-year-old woman with type 2 diabetes, circulation and immune function are already impaired. That infection rapidly progressed into sepsis, meaning the infection entered her bloodstream and triggered a whole-body inflammatory response. Sepsis is one of the most dangerous conditions in all of medicine. It can cause acute respiratory failure, kidney failure, and cardiovascular collapse, and that is exactly what happened here.

The combination of sepsis, COPD (Chronic Obstructive Pulmonary Disease) — which already meant her lungs were not working well before any of this — and her body weight all contributed to acute respiratory failure, and that’s why she went on the ventilator. She has now been on the ventilator for over 30 days. This is what we call prolonged mechanical ventilation, and this changes everything: the approach, the options, and the plan.

Why Can’t She Come Off the Ventilator?

This is one of the most important questions Georgia needs to be asking the ICU team. There are several reasons a patient may struggle to be weaned off the ventilator:

1. COPD — Her lungs were already significantly compromised before this. She may not have enough lung reserve or respiratory muscle strength to breathe without support.
2. ICU-acquired weakness — After 30 days in bed, often sedated on opiates such as morphine or fentanyl, patients develop severe muscle weakness, including in the breathing muscles. This is a real and recognized complication of prolonged ICU stays.
3. Kidney failure — Impaired kidneys affect electrolyte balance, fluid levels, and the acid-base environment the body needs to breathe effectively.
4. Obesity — At 365 pounds, the mechanical work of breathing is significantly increased. The respiratory muscles have to work much harder, and the chest wall and diaphragm have reduced compliance.
5. Underlying neurological factors — She already has left arm paralysis. Is there an underlying neurological condition contributing to her respiratory failure? This needs to be investigated.

The Delayed Tracheostomy: What You Need to Know

A tracheostomy should generally be considered between day 7 and day 21 in patients who are unlikely to be weaned off the ventilator and breathing tube quickly. Georgia’s sister is now past day 30. The fact that it has been repeatedly scheduled and not performed is something you absolutely need a direct and specific answer about.

Ask the ICU team what specifically is preventing this procedure from being done right now. Is she hemodynamically unstable? Is there a coagulopathy? Is it a surgical access issue related to her weight, or is it a scheduling issue? These are different problems that require different solutions, and you need to know exactly which one applies in this case.

A tracheostomy is critical because it is more comfortable, it reduces the risk of pneumonia, it makes weaning easier, it allows the use of a speaking valve, and it is necessary before transfer to most rehabilitation facilities.

Why Medical Records Are Non-Negotiable

Georgia, and anyone watching who has a loved one in the ICU: you must request access to all of your sister’s medical records. This is your right. Without those records, you are working completely in the dark.

You need:

• Nursing notes
• Medical progress notes
• Ventilator records and weaning trial documentation
• Laboratory results
• Microbiology results showing what’s causing the sepsis and what antibiotics are being used
• Physiotherapy notes
• All imaging reports — Chest X-rays, CT scans, ultrasounds
• The medication list

Here at intensivecarehotline.com, when we review medical records for families, we routinely find critical clinical information that families were never told about — things that change the entire picture. You cannot advocate effectively without this information. Go to the hospital’s medical records department today and make a formal written request. If you’re not the legal next of kin or health decision maker, sort out that authorization first, and if so, do that today.

How My Team and I Can Help

This is where my team and I come in. At intensivecarehotline.com, we work directly with ICU families to review medical records, explain what is happening in plain language, identify what the team is and isn’t doing, and advocate directly with the ICU team on your behalf. We can attend family meetings with you by phone, Zoom, Google Meet, Microsoft Teams, or in person, and ask the hard questions the team may not be volunteering answers to. We question the clinical plan, push for accountability, and help you understand your options.

For Georgia’s situation specifically, a consulting call with my team would give you a clear picture of whether the current plan is appropriate, what should be happening that isn’t, and what your sister’s realistic options are, both short- and long-term.

The best way to work with me and my team is to call one of the numbers at the top of our website, book a call through the scheduled appointment button on our website, or email us at [email protected].

Treatment Options for Georgia’s Sister

1. Optimize treatment of underlying conditions — the right antibiotics for the sepsis guided by blood culture results, tight blood glucose control, aggressive nutrition, kidney support (potentially including dialysis or Continuous Renal Replacement Therapy (CRRT)) and active physiotherapy and rehabilitation even while she’s on the ventilator.
2. Perform the tracheostomy — this needs to happen. If the current team is struggling due to her weight, they need to involve a specialist Ear, Nose, and Throat (ENT) surgeon or thoracic surgeon with bariatric experience. Specialist techniques are available.
3. Implement an aggressive, structured weaning program — daily spontaneous breathing trials, gradual reduction in ventilation support, and respiratory physiotherapy.
4. Investigate her neurological status — even without an MRI (Magnetic Resonance Imaging), a Computed Tomography (CT) brain scan with contrast is possible. A neurology consult should happen, and nerve conduction studies can be done at the bedside.
5. Plan for a transfer to a specialist facility once she’s stable enough — there are specialist ventilator weaning units that are far better equipped for this kind of complex, prolonged weaning than some ICUs.

What If She Can’t Come Off the Ventilator?

This is the conversation Georgia’s family needs to start having now, proactively, so that you are in control of the decisions rather than reacting to a crisis. If your sister cannot be weaned from the ventilator there are three main pathways:

1. Long-term ventilation at home. This is where Intensive Care at Home (intensivecareathome.com) comes in. Go and check out our website at www.intensivecareathome.com.   We are a third party-accredited specialist home intensive care nursing provider for ventilator-dependent and tracheostomy-dependent adults and children. We provide 24/7 critical care registered nurses in the home, managing invasive ventilation with tracheostomy, non-invasive ventilation such as Bilevel Positive Airway Pressure (BiPAP), tracheostomy care, enteral nutrition, medications, and monitoring simply everything. The goal is to keep patients like Georgia’s sister out of the ICU predictably and permanently — not just for quality of life, but to prevent the cycle of ICU readmissions that is so common in patients with complex comorbidities. Currently, with intensive care at home, we are operating all around Australia, in all major capital cities as well as in all regional and remote areas basically in all states and territories. And we are registered with the National Disability Insurance Scheme (NDIS). But even if you’re in the US, the UK, or Canada, and you’re watching this, and you want to inquire about intensive care at home, please call us anyway because we can help you privately and we can show you the right steps to take.
2. Transfer to a specialist long-term acute care or ventilator weaning facility — if you are in the US, this is called a Long-Term Acute Care (LTAC) facility, where the focus remains on continued weaning attempts in a less acute environment. Another option is a step-down ICU within the hospital, though we would recommend an LTAC if you are in the United States.
3. A palliative care approach — if the prognosis is very poor and the family determines that ongoing aggressive treatment is not in keeping with the patient’s wishes or values, this pathway focuses on comfort and dignity. This is a deeply personal family decision and one that should be made with proper information and proper consulting, not under pressure.

What Should Georgia Do Right Now?

1. Request all medical records in writing today.
2. Ask for a formal family meeting with the attending intensivist, respiratory physician, physiotherapist, and other members of the team.
3. Ask directly why the tracheostomy has not been performed, and what the specific plan and timeline are.
4. Ask what the structured weaning plan is and how progress is being measured.
5. Ask what the plan is if she cannot be weaned.
6. Contact us at intensivecarehotline.com — call one of the numbers at the top of our website, email [email protected], or book a consulting call through the scheduled appointment button on our website.

Let us review your family member’s medical records, help you understand exactly what’s happening, and advocate for you with the ICU team on your family member’s behalf. You are not alone in this. You are fighting for your sister, and that fight matters.  Please reach out to us at intensivecarehotline.com and call us on one of the numbers on the top of our website or simply send an email to [email protected]

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.