Intensive Care Hotline

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September 17, 2020 / Patrik Hutzel - Critical Care Nurse Consultant / No Comments

Quick Tip for Families in ICU: When to Remove a Tracheostomy?

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

So this week, we were working with a client who wanted to know what needs to happen for the tracheostomy to be removed or paraphrasing the question differently is, when can a patient with a tracheostomy be decannulated?

So here is the quick summary of this.

So a tracheostomy can be removed when a patient is off the ventilator, has a good, strong cough, can manage their own secretions. It’s almost strong enough to cough out the tracheostomy just with a cough.

Next, they can tolerate a speaking valve for a few hours, and next there are minimal oxygen support and so basically breathing on room air.

Next, they need to have passed the swallowing test or a blue dye test that shows that they can swallow so there’s no risk of aspiration once the tracheostomy has been removed.

And last but not least, an arterial blood gas should be done and you should be particularly checking for the oxygen levels in the blood and the carbon dioxide levels as well as the pH levels.

So that’s my quick tip for today.

This is Patrik Hutzel from intensivecarehotline.com. Go and check out our website intensivecarehotline.com. Call me if you have a loved one in intensive care and you’ll need consulting and advocacy.

Comment down below this video what questions that you have. Like the video and subscribe to my YouTube channel.

Take care.

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"Hi, Patrik.

You saved my mom's life! After her RV transport from Connecticut to San Diego on January 6, I got her local medical support during her recovery (physical therapy, OT, a few home blood draws and nurses, oxygen prescribed, hoyer lift, etc.). She got a CT scan at the hospital and saw her doctor on March 15. He would never have approved her for air travel with her oxygen needs so we didn't even ask. On March 17, I drove her from San Diego to Tampa. On March 23, we got on a 14-night transatlantic cruise to Barcelona, and on April 6, we drove to Oslo in Norway. Here is the photo of us and the dogs on the cruise! Thanks to you, she got to do her life goal of being on a cruise!

Best wishes,Debra."

Hello Patrik.

Mom got the tracheostomy out just before Christmas then they sent her back to her hometown (clearing wards before holidays). They left her in ED for 2 days before moving to ward. She got a bit more awake and refused to have the feeding tube reinserted so I got a retired nurse to help me sort that out and they called it risk feeding, eventually got to the rehab ward and then home. It was a rigmarole, probably timing of holidays did not help. She persuaded them to let her go out of rehab after a couple of weeks. She uses a wheelie Walker and wheelchair to get around.

I had to go back to the big city at the start of February to remove an IVC filter. It was hard work getting her back, obviously she didn't want to go back, and travelling on public transport with a person who can't get very far with a walker was quite an experience for me.

But we got there and she is back home with dad now. She has improved but it is slow. She has good days and then not so good ones, as we all do I guess. She will probably get back to walking unaided, it might take a few more months. It is her main problem. Without that she really is not far off her old self. So glad she got out of there with so little repercussions, compared to what the doctors were describing in those family meetings.

So sad that has been our hospital experience though, to go in to recover from pelvic fractures and come out with that experience is really awful. Apart from poor eyesight, she had no obvious health issues, and hadn't been to a doctor for many years. Lucky to get out I guess. I was really glad to have your service, it helped me a lot. Many thanks..

Sincerely,

Barbara

MY REVIEW OF INTENSIVE CARE HOTLINE

So on Friday, February 9th, I checked my 88 year old mother into a local hospital because of the following symptoms: slurred speech, a steadily decreasing appetite, confusion, and legs so weak that she needed help to walk to my truck outside even though she'd been walking fine the day before!

I managed to get her into the emergency room quickly, where a series of tests and readings revealed the following: blood pressure roughly 60 over 40, a pulse in the 40s, and a probable urinary tract infection or uti. And the ER doctor told me, "Your mother is very sick." He then asked me, "If her heart goes out, do you want us to do everything we can?" I answered, yes-- and the emergency room team was fantastic!!! and next thing you know--after more tests--she was sent to Intensive Care Unit, or ICU.

So the next day I got a call from the nurse in ICU, and she was asking me about a baseline, about how my mom spoke normally. Well, I like face to face communication, so I went in to meet the nurse and her assistant and see my mom and my mom looked like death warmed over. She didn't look awake, or like she'd ever be awake again! The nurse then started a long statement about the possibility of her heart stopping and the only options in that situation and how devastating that would be for my mother and did I want to consider do not resuscitate or DNR, but I was too afraid to make a decision. (She also talked about something about comfort, which I think means turning off machines, but I didn't like that idea, either!) So I went back with a friend whose best friend is a rn in Atlanta, and my friend agreed with the ICU nurse. "I've seen this before, your mother is going to die. You need to be prepared for that. To let them do compression or anything to keep her alive after a heart attack is cruel." And even with medication, all my mom's readings looked shaky: her blood pressure was bouncing around with numbers like 80 over 40--and she was on two kinds of blood pressure medication!!!-- and her pulse was still going between 40 and 80. Her oxygen was good, but that seemed to be all she had going for her. So I was depressed. I didn't see any way out. I saw an immediate future without my mom, and with no wife and no kids myself, what would that mean for me? I could survive, but it wouldn't be the same. And all these people--the ER doctor, the ICU nurse, my friend;s buddy the rn, plus, my friend who said she'd seen cases like my mom's before and she knew it was coming--they all couldn't be wrong, right?

So I couldn't sleep that night, but early Sunday morning of February 11th, I had a brainstorm: I would go online, and see what I found. And that's what led me to INTENSIVE CARE HOTLINE and Patrik Hutzel. I looked at the website, read that Patrik was a critical care nurse, seemed to have lots of experience plus lots of videos, and he even offered a free consultation. "Why not?" I thought. But it was 4:00 in the morning! But then, I added, "He's got lots of funny phone numbers, so maybe he won't mind?" So I made the call, and to my surprise, Patrik answered immediately.

I asked about rates and about his free consultation, and soon we started with the consultation: Patrik asked all the right questions, like what was wrong with my mother, what were her symptoms, and where was she now. I could tell he was German, and smartT--he talked to me at length about urinary tract infections and their symptoms and treatment-- but once he started getting into his wheelhouse of critical care, Patrik was like Boris Becker at Wimbledon with one big serve after another!!!

"It's too early, the medicine needs time to work on your mother..."

So after I gave Patrik the basics, he said, "It's too early, the medicine needs time to work on your mother. Give it another day."

"HUH???" Why wasn't anybody at the hospital telling me this??? So I told my friend--the one with the rn friend. Here's what she said:

"So you're going to listen to some guy 800 miles away???"

So after I told my friend with the rn friend about Patrik she said, "So you're going to listen to some guy 800 miles away?"

So the battle lines were drawn: it was an er doctor, and icu nurse, my friend, her friend the rn, all saying or suggesting my mom was KAPUT!!!--now there's a good old stereotypical German word!!!--and the guy from the internet saying to give the medicine time to work, at least another day. Maybe there was some glimmer of hope for my mom, after all.

So my friend was urging me to tell the people at the hospital not to resuscitate, or DNR!!!

But Patrik had put his big German thumb on the scale and my mind was made up: I'd wait another day, just like he told me to.

TOMORROW NEVER COMES?

Someone once said tomorrow never comes, but this time it did, and so when I finally got the courage to go see my mom in icu, I went with my friend just in case and guess what? MY MOM WAS AWAKE!!! AND HER NUMBERS WERE GETTING BETTER!!! WAS THE GUY FROM MILES AWAY RIGHT???

Next thing you know, my mom was being sent to a regular room where she's continued to show steady improvement, with her only remaining symptom being some weakness in her legs. Her pressure numbers have stabilized to where she's off of all the blood pressure medicine, her pulse is normal, her speech is normal, and her appetite is normal. Her only remaining symptom is weakness in her legs.

And so, THE GUY FROM 800 MILES AWAY ENDED UP BEING RIGHT!!!

Patrick and I also talked about DNR, and he told me how he's against it, I think because it sets a medical team on the wrong path, but I've got to talk with again to make sure! But I know it would have been the wrong path for my mom!!!

So the lesson in all this is clear: if you have a medical question or problem and you're not happy with the answers you're getting,

call THE GUY FROM 800 MILES AWAY!!!

CALL PATRIK HUTZEL--TODAY!!!

THANK YOU VERY MUCH!!!

CHARI

"Hi Patrik and Intensive Care Hotline Support,My husband ended up in ICU, after being found unconscious. X-rays showed he had aspirated into his right lung, and was put on a ventilator to support him whilst treating for pneumonia. This was quite a frightening time for me. I really didn't know what was going on, or what should be going on in the ICU. The staff were quite friendly, but kept the discussions very simplistic. I felt powerless.It wasn't until I accessed Patrik Hutzel's expertise that I started getting real answers. Not only was he willing to speak to staff directly, he told me what sort of questions to ask which would encourage the doctors to talk to me at a deeper level. My husband had been in ICU for two weeks and all measurements were showing he was good to be weaned off the ventilator (Patrik taught me what indicators to ask for). However, because of a previous failed extubation and general weak muscle tone, the doctors didn't see it would be successful and were leaning towards a tracheotomy.I was armed with all the right questions, and seeing my keenness to give it a go, they proceeded to take the tube out and put him on a bi-pap. Wonderfully it was successful, and significantly shortened any further stay in ICU. This moment was very crucial, as the longer my husband stayed in the ICU, the more weight and muscle he lost. I am so grateful for Patrik, as I feel it improved the outcome for my husband. Plus he metaphorically gave me a map and compass to navigate this very different experience.I can happily say that my husband is now doing really well. Thank you to Patrik and his team.Sincerely,Jane"

"Hi Patrik and Intensive Care Hotline Team,

My husband is finally out of ICU and in a hospital ward. He has been gaining his strength and movement back in leaps and bounds after being in ICU for 3 weeks.I am absolutely grateful for Patrik's advice. The Drs thought he had a high chance of failing the second extubation. It's really only because I knew what language to use and what questions to ask, that they agreed to try again before a tracheostomy. But my husband did succeed with the extubation, by being put on a BiPAP, and being given some relaxant. He moved from that to nose prongs, and then eventually breathing on his own. Oh my gosh! How much time was saved from being in ICU, by Patrik's guidance. Alot!!!"

Shiela

"Hello Patrik,

I hope you are well.My husband is on the ward!Everything you said was correct! He was ready to come off ventilation and he did.I'm hoping we can give a zoom chat for the next half hour to discuss what now as he is on the ward with the nasal prongs and small oxygen.

Thank you Patrik."

Dezi

"Hello Cheryl, I'm happy to report that Jorge is doing well! He is more happy and really enjoys going out or just spending time with the family. He is really trying to talk and he is making more sounds, he is consistently very awake throughout the day. It's almost like a fog is lifting from his brain, it really makes me happy and amazes me how he continues to protect his kids, and his personality is pretty much the same! e.g. keeping an eye on his kids when we are at the store, the park, when they are playing at their house. When it's dark, he points to the door and tries to push his wheelchair to lock it, or to the window blinds to close it. He has really learned to communicate through gestures and sounds, and his kids even understand him now. When he sees our mom, he opens his arms to hug her and kiss her. When his wife is helping him to transfer from WC to bed (he no longer needs hoyer lift), he flexed his arm and look at her, telling her she is strong, that was really funny and it seems that he is more accepting of the help now and is coming into terms of what his condition is at this time.

I know in God's time he will regain his speech and be able to walk as he is really moving more, and is very motivated. I believe God is preparing him to live a life without alcohol, which was Jorge's biggest wish to be able to stop drinking, but he was just so afraid and always had the panic attacks. He still has claustrophobia and I pray that goes away. But in general he is progressing. I will send some pictures/videos to Patrik so you all can see him.

Milagros, I also want to thank you for the great and detailed info about my question. Thanks again to all of you! I dream that one day, Jorge can be well enough to at least virtually meet Patrik and all of you who have been a fundamental part of this painful, but rewarding journey in my brother's day by day recovery.

Always grateful,"

Nancy

Your service has been so helpful during this time with my Father's heart attack and stay in the ICU. He's currently in another wing of the hospital and waiting on a few medical concerns to clear before transferring to an inpatient rehabilitation center, not a nursing home or LTAC! I want to thank you so much for your service and the support our family has received.It's been so valuable to be able to advocate for my Father to receive the best possible care for his recovery.

-Deborah

Hi Patrik,Hope this email finds you well.I'm not sure where we left off and whether you recall my father's particular case.I had been in contact with you at the beginning of last year when my father was hospitalized with pneumonia then later put on a mechanical ventilator for 2 months. The doctors told us that his chances were not good.I want to tell you that my father survived, he eventually woke up and was taken off the ventilator however he subsequently was given malaria infected blood during a necessary blood transfusion and he was readmitted to the ICU. This started another process of fighting for survival, eventually he was sent to another hospital that specializes in infections diseases and they are were able to treat his malaria with strong anti virals. Altogether he required a lot of therapy , dialysis, hospital visits with different specialists to rehabilitate and although fragile he is alive and well today. I'm not sure if I ever had the chance to update you on his condition and I apologize if I did not, it was really a hectic ordeal and I got lost in the thick of things. My family and I want to give you our most sincere gratitude and appreciation for providing the support you did throughout what was one of the most critical periods of all our lives. The guidance you were able to provide and also stepping in to talk with the doctors was incredibly supportive and immeasurable. We cannot thank you enough for everything. We are all grateful for what you do and it is a blessing that we were able to find you. I wish you always the best of health and happiness, you deserve it all.

Tony

Thank you for your incredibly valuable information, assistance and advice. My partner just came out of the ICU to a ward bed.He had an accident at home a few weeks ago which left him with a fractured pelvis in 4 places, 4 broken ribs and a few fractured vertebrae. He then developed a DVT and subsequently, several small but life threatening pulmonary embolisms.Your videos helped me understand how ICU works and what decisions they may ask of us to make.Fortunately, we didn't have to make any of those decisions. Although, knowing that there is advocacy for ICU patients, makes the process much less stressful and less lonely.Thank you!

@devonrex4959

Hi team! Hope you are all well. Dad is doing as good as possible right now. This past weekend made one month since he's been home! We've changed his diet & meds back to whole foods & natural supplements. Thankfully we have had no issues with the peg tube so far. He's even started to eat & drink very small amounts of fruit & water when he feels up to it. He's currently receiving physical, chiropractic, & hyperbaric oxygen therapies. His mental status has improved slightly. We understand from all that are working with him that this will be a slow recovery. But there is hope. My family & myself cannot thank each of you enough for all the knowledge, guidance, & time, you all gave us during the fight of & for his life. We are forever grateful. As always, thank you so very much! Talk to you soon.

-Meli

Hello Patrik and Team,Thank you so much for all that you've done to help my brother and my family! I'm thrilled to report that Steve went home today. He's eating on his own and walking with the help of a walker. His recovery has been almost miraculous. Your organization was a huge part of that. We cannot thank you enough. His wife has taken leave from work to be with him full time. Since he's no longer in critical care we would like to cancel our membership. Hopefully we won't find ourselves in a similar situation in the future, but God forbid, if we do…..we know that you guys are there. God bless each and every one of you for the amazing work you're doing!

-Lisa

Dear Patrik,

First I want to thank you for being a vessel of light in a very dark cold place for my mom and my family. I sincerely believe that some divine intervention led me to find your channel on YouTube and when I felt like throwing in the towel you kept encouraging me to stand up and advocate for my mom. You don't know how grateful I am for your knowledge, wisdom, and expertise in our time of need. You have been an instrumental voice for the voiceless, and hope for the hopeless. Your discretion in this matter, all the resources you have sent me, including all the follow up emails and voice messages, showed me that you are reliable, responsive, informative, and a person of great character and integrity. On behalf of my family and myself I thank you for being that vessel of justice for the people.

-Tisha

This is very long overdue, but I just wanted to take a quick minute to say thank you. The information and advice you gave me literally helped me to save my husband's life when he nearly died from covid while in a medically induced coma in ICU.I owe you more thanks than I could possibly put into words, but I thought the least I could do is just take a minute and let you know how much you really make a difference in people's lives you're truly an angel. Thank you.

Lara Westphal

I just want to thank Patrik and his amazing team for all the support and help that has been offered to my family and I.I truly have no idea what we would do without you all. Finding this intensive care hotline has been such a blessing for us. Since my grandmother being admitted into the hospital 6 weeks ago, I have learned so much. You have given me the strength to continue fighting and standing my ground to be the best advocate for my grandma. This is such a safe place for so many families, & I am so happy to know there are genuinely good people out there trying to help .We are so grateful for you all.

Melina

I can't thank you enough for giving me the power to take control of his care, peace of mind, and being in control of his care. I am going to be signing up for monthly subscriptions/membership and possibly an hourly consultation. You have given me the motivation to keep up with fighting the hospital and them pressuring us for outside facilities. So sad that money is more powerful than a person's recovery. You have helped guide me through the process by watching your videos and having the courage to stand up to the hospital pressures. I told them today, I'm the last person you want to mess with. Sorry for the language but that's the truth! They want to wear you down to give into what they want not what my dad needs. I can't thank you enough for your support and help. I will be chatting with you shortly! Thank you again for helping families in a crisis that don't know what we don't know!!

Traca

Thank you for everything. Without you, I would lose my mind. It was really hard and although my father didn't recover as much as we hoped, you helped us to accept it and still gave us hope, that there is still some little chance that he will recover a bit more. Thank you from my heart, you are a life saviour. Keep doing great work!

Petra

You may not remember, but back in 2017, we spoke briefly while my son was in the ICU. Your advice proved to be gold dust. I was able to buy time for my son and here he is this month ready to celebrate his 5^th birthday! I can't thank you enough. I think what you do is incredible. You are a true legend hero and inspiration to mankind Patrik!

Cassie

"Patrik, I just want to thank you. In early 2021, my partner was in a Neuro ICU unit. You have no idea how much emotional support and knowledge I attained from watching your videos. You saved two lives here in the US. My warmest appreciation!"

Poquott Life Matters

"Patrik has provided superior care for my mother and grandmother. He assisted my family in 2018 and 2021. He is compassionate and shares his expertise in order for the family/loved ones to be more informed about their loved one's condition and make informed decisions. I felt more empowered when discussing health matters with my mother and grandmother's providers after speaking with Patrik to better assist my loved ones."

Javiere Norris

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