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

Today’s tip is about, cardiac arrest, hypoxic brain injury, and then the outlook of a tracheostomy and LTAC, home care and how to choose the best option for you and your loved one. So here’s the situation.

A 55-year old man had a cardiac arrest out of hospital, had some significant downtime, until they could reestablish the heartbeat and the blood pressure, which led him to have a hypoxic brain injury as well. Now he’s in ICU for 10 days, on a breathing tube, and on some sedation. And the ICU team is pushing for either tracheostomy, PEG (percutaneous endoscopic gastrostomy) tube and LTAC, or end-of-life.

Bear in mind, this man is 55 years of age. He’s not brain dead. He does have, by the looks of things, a significant hypoxic brain injury, but that doesn’t mean, you should be rushing things.

Now, the first question for our client, that I set to our client to ask is, have they done everything beyond the shadow of a doubt to get this man off the ventilator and the breathing tube, and avoid the tracheostomy rather than pushing for a tracheostomy?

It turns out that with a Glasgow Coma Scale of 5 and him not waking up after being off sedation, it looks like, a tracheostomy is the right next step. But nevertheless, you should always ask that question. Have you done everything beyond the shadow of a doubt to get my family member off the ventilator and the breathing tube and avoid the tracheostomy? If you can verify that, fair enough. Maybe tracheostomy is the next step, but you should verify. How can you verify? You can verify by talking to us. There are articles on our website, how to extubate someone?

You shouldn’t trust. You should verify. You should talk to the expert. You should seek a second opinion, which is what we can help you with.

Next, now that we established that tracheostomy is probably the next best step for this client, they’re also wanting to push for a PEG (percutaneous endoscopic gastrostomy) tube so they can move him to LTAC. Now, our advice is you can consent to a tracheostomy, but not to a PEG because LTACs won’t take patients without a PEG tube.

Patients can have a nasogastric tube. That’s perfectly fine. We’ve looked after patients in ICU for over six months with a nasogastric tube. There’s no need for a PEG (percutaneous endoscopic gastrostomy). A PEG is for someone that can definitely no longer take any oral nutrition where you know for sure that they need a PEG. That’s their only way of getting nutrition. But after day 10, that’s way too early to establish that.

So don’t let people push you around. Do your research. Ask the right question. And quite simply put the brakes on. Don’t let them push you to LTAC within a few days. LTACs are a disaster.

This video is mainly for our U.S. audience. I should have said that in the beginning. It’s mainly for our U.S. audience where patients often get moved from ICU to LTAC. If you’re not putting the brakes on.

So what is the right next step for this particular client? So the next step is, he should have a tracheostomy. No PEG. He can have a nasogastric tube and he can be fed by that. Then it needs to be established. Can he be taken off the ventilator? Is a tracheostomy more comfortable for him than a breathing tube? Most likely, yes.

Tracheostomies are generally speaking more or better to tolerate than a breathing tube. Of course it would be best to have the breathing tube removed. But as I said, with the Glasgow Coma Scale of 5, he can’t protect his own airway. He can’t swallow. He can’t obey commands at the moment. So a tracheostomy is probably the right next step.

So once that’s done, let’s see whether that particular client can have a time off the ventilator. And then let’s look at what is next. Should he go to LTAC? Should he go to a step down ICU? Should he go to a neurology rehab center? Can he go home with a service like Intensive Care at Home? Those are the type of questions you need to ask.

I hope that helps for today.

If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of the website, or send us an email to [email protected].

Also, have a look at our membership for families in intensive care at intensivecaresupport.org.

If you need a medical record review for your loved one, while they’re in intensive care, or when they left intensive care, contact us as well. There’s a link to that specific service as well.

Thanks for watching this video.

Like the video, share it with your friends and families, subscribe to my YouTube channel, for updates for families in intensive care, click the notification bell, and leave your comment below what you want to see next, or what questions and insights you have.

Thanks for watching.

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