Quick Tip for Families in ICU: When Is a Tracheostomy Inevitable?

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

So a lot of the questions that we get when someone has a loved one in intensive care, on a ventilator with a breathing tube and they can’t wake up out of the induced coma and they can’t be weaned off the ventilator is whether a tracheostomy is inevitable or not.

And they’re saying, every time that they try to wake up their loved one out of the induced coma, they’re breathing against the ventilator, they’re distressed, they’re agitated. And then the ICU team has to re-sedate them, put them back in a coma, therefore prolonging the induced coma and also prolonging the time on a ventilator. And the longer someone is on a ventilator, the less likely it is they can actually come off the ventilator, and then that’s when inevitably the discussions around a tracheostomy come up.

So let’s look at this in more detail. So, yes, I have seen in over 20 years of intensive care nursing, that patients, when you try to wean them out of the induced coma, that they are struggling with waking up, they’re not coherent, they’re breathing against the ventilator. They can’t be extubated because they’re neurologically not intact. They can’t follow commands and so forth.

So what to do in a situation like that, you’ve got to keep trying, but at the same time, you’ve got to look at, do you need to change sedation? Do you need to change from propofol to midazolam? Do you need to change from midazolam to propofol? Do you need to change fentanyl to morphine or the other way around? Do you need to change ventilation settings?

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They’re jumping to conclusions without looking at the details. Again, when someone is in intensive care critically ill, there are dozens of things happening simultaneously and unless you understand these things that are happening simultaneously, in-depth like I do, you will have a very hard time in guiding the care and treatment for your loved one in the right direction.

Families in intensive care don’t know what to look for. They don’t know what questions to ask. They don’t know their rights. And they also don’t know how to manage doctors and nurses in intensive care to get better outcomes.

So the best way forward if your loved one can’t come off a ventilator with a breathing tube and they need to do tracheostomy because they can’t come out of the induced coma is to talk to me. Talk to us here at intensivecarehotline.com. We can talk to the intensive care team and find out, are they doing all the right things? Are they being transparent? Are they telling you everything that is happening? And the reality is most intensive care teams, don’t tell you everything that’s happening because you’re not asking the right questions.

So that is my quick tip for today.

This is Patrik Hutzel from intensivecarehotline.com and I’ll talk to you in a few days. Like this video, comment down below what you want to see next, and subscribe to my YouTube channel.

Take care.