Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.
Today, I want to exclusively talk to our audience in the United States and I want to talk about when it comes to the decision-making criteria around when to do a tracheostomy.
Now you’ve heard me say before that a tracheostomy should be done after 10 to 14 days of mechanical ventilation with a breathing tube and the inability to wean off a ventilator. Those are the guidelines and they are the guidelines across the world.
However, there is such a big flaw in the US in particular, when it comes to the follow-on support when someone has a tracheostomy. Again, you’ve heard me say before if you are watching these videos regularly, that most patients in the United States, when they have a tracheostomy in ICU are being sent to LTAC or subacute facilities as quickly as possible. And that is just the care that’s provided in subacute or an LTAC. It’s just not up to the standards for a ventilated patient, with a tracheostomy. They’re making all these promises on their websites, that they can wean patients off the ventilators, and they publish their success rates, but what we see in practice, it’s just not happening.
And the reason from my perspective is simply that in ICU, you have ICU doctors, ICU nurses, respiratory therapists, highly trained, highly specialized on ventilation and tracheostomy. And then you’ve got LTAC, which is the better version of a nursing home and you’re basically sending people from critical care and ICU to a better version of a nursing home, and that in my mind is just medical negligence. So, whilst we can’t fix the system, what I want you to be aware of is, you need to be aware of the flaws in the system, and you need to think your decisions through carefully.
And you need to question everything that you’ve been told, which is pretty much LTACs and subacute facilities are promising you that they can get your loved one off the ventilator. Nothing could be further from the truth. And ICUs are telling you, “Let’s do a trach and then send them to LTAC or to subacute so they can be weaned off the ventilator because they don’t do it in ICU.”
Now, if you look at countries like Australia or the UK, patients have a trach and then they get weaned off in ICU often successfully, and why do they get weaned off in ICU successfully? Quite simply, because the skills and the expertise are there to wean patients off the ventilator, whereas LTAC in the United States or subacute, it’s just as cost-saving exercise for the health insurances and a vehicle to empty ICU beds.
Whilst you can’t tiptoe around the decision-making around whether to have a tracheostomy or not, you need to think things through. One alternative is to look at services like intensive care at home. So go and check out intensivecareathome.com to continue care and treatment at home with intensive care nurses that have the skills and the expertise to be in patients off the ventilator at home, because it’s certainly not happening in the LTAC as we know from experience.
So that is my quick tip for today.
This is Patrik Hutzel from intensivecarehotline.com.
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Have a great day and take care for now.