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If you want to know if your critically ill loved one, husband, at the age of 87, should have a tracheostomy in ICU, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care.

So today, I have an email from Sharon who says:

“Hi Patrik,

My husband has been on a ventilator for about 16 days. They want to do a tracheostomy on him. He’s 87 years old, and before he started his 10-month hospital and nursing home trap, he was very busy and active, working. He worked in the yard for 5 hours every day, and he absolutely loved it.

My question is, should we do a tracheostomy? Anesthesia at his age is risky. If he does and he gets better, how hard is it to reverse this?”

Sharon, I’m very sorry you’re going through this difficult time with your husband. Deciding whether to proceed with the tracheostomy is a significant decision, and I’ll do my best to help you consider the facts and the factors involved. What does a tracheostomy entail? A tracheostomy is obviously a surgical procedure where an opening is made in the neck to place a tube into the windpipe or trachea. This bypasses the mouth and the throat, allowing easier access for long-term ventilation.

Why is it recommended? If someone has been on a ventilator for more than 10 to 14 days, which is the case in your situation it’s been 16 days now, a tracheostomy is often suggested to reduce the risk of complications like vocal cord damage or infection from the current intubation, make weaning off the ventilator easier if improvement is possible, and improve comfort and quality of life compared to prolonged intubation through the mouth.

Also, because at the moment, your husband would be on sedation and opiates to keep him comfortable, the minute the tracheostomy is done, he no longer needs sedation or opiates, and then he can actually wake up. From my extensive experience, the minute your husband has a tracheostomy, sedation can be switched off. 

Next, risks in older adults. At 87, undergoing anesthesia and surgery does carry increased risks, but a tracheostomy is generally considered a relatively minor, quick, and safe procedure. However, the success depends on his overall condition, including his current strength and reserves after months of hospitalization, other underlying medical conditions, and how reversible the illness causing his need for ventilation might be.

The reversibility. A tracheostomy is not necessarily permanent. If your husband improves enough to breathe on his own, a tracheostomy can be removed, and the opening will heal over time.
In older adults, this process can take longer, but it is possible if his underlying health improves. But also, what you haven’t shared is, what ventilator settings is he currently on? What sedatives is he on at the moment? What opiates is he on? 

If sedatives and opiates can be removed, will he start breathing on his own more and more? And this is one of the many reasons why I keep saying that 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. That is exactly the case in your situation, you don’t know what you don’t know. 

For example, what are his arterial blood gases like? What do chest X-rays look like? Have they done any spontaneous breathing trials? If they haven’t done any spontaneous breathing trials, is he on too much sedation and too many opiates? What other questions should you be asking the intensive care team?

Prognosis with and without the procedure. What are the chances of recovery or improvement with the tracheostomy compared to continuing with the current ventilation method? Can he be weaned off the ventilator in a timely manner without needing a tracheostomy?

Quality of life considerations. If he improves, what will his functional ability, capacity, and independence likely look like? And even if he doesn’t improve, would he still want to live with quality-of-life impairments? What are his long-term needs? If he doesn’t improve, would the tracheostomy mean permanent reliance on a ventilator? If yes, then, you have to consider Intensive Care at Home. For more information, go and check out intensivecareathome.com.

Risks of anesthesia. How do the risks of anesthesia compare with the risks of continuing the current course?

Emotional and practical considerations. It’s also important to consider his wishes. If your husband previously expressed thoughts about how he wants to be treated in a situation like this, that could guide you. Consider discussing with the medical team, including palliative care, who can balance prolonging life with comfort and dignity.

How are you feeling about his current condition and the road ahead? Do you have family and trusted friends to support you in this decision and also potentially the care he might need down the road? Once again, if he does end up staying on a ventilator with the tracheostomy long term, you can consider Intensive Care at Home, which, from my extensive experience, would be the best option then.

But bear in mind, the goal in this situation should always be to wean him off the ventilator, whether that’s now with the breathing tube, or with the tracheostomy as a next step. The goal must be to wean him off the ventilator, and if that, God forbid, fails, then Intensive Care at Home can be considered as an option.

What is important is that your husband needs physical therapy, mobilization, as quickly as possible, and to have sedation switched off as quickly as possible. Only then will he improve. He can’t be lying in bed for another 16 days because then you won’t see improvement.

So, I hope that explains your husband’s situation.

I have worked in critical care nursing for 25 years in 3 different countries, where I’ve worked as a nurse unit manager for over 5 years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com.  I can very confidently say that we have saved many lives for our clients in intensive care. You can verify that on our testimonial section at intensivecarehotline.com. and you can verify it on our intensivecarehotline.com podcast section at intensivecarehotline.com where we have done client interviews, and you can see what our clients have to say in the interviews.

We have helped hundreds and hundreds of members and clients over the years, and you can become one of our clients and members, and we can help you very, very fast. You’d be surprised how quickly we can help you. I know our clients are constantly surprised by how quickly we can turn situations around and how quickly we can give life-changing advice, literally life changing advice. That’s what it comes down to. Families in intensive care 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.

That’s one of the reasons why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you can’t afford to get wrong.
When I talk to you and your families directly, I make sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment.

At the moment, you probably think this is so far outside of my reach, outside of your reach, that it’s impossible, but we make the impossible possible. And once again, we give life changing advice that changes the trajectory of your critically ill loved one’s life for the better.

I also talk to doctors and nurses directly. When I talk to doctors and nurses directly with you or on your behalf, I ask all the questions that you have not 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 have a second opinion in real time.
We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence. 

All of that you also get this in the membership because we have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com 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.

All of that you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care. Click the like button, click the notification bell, and comment below on what you want to see next, what questions and insights you have.

I also do a weekly YouTube live where I answer your questions live on the show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel, or if you’re a subscriber to my intensivecarehotline.com email newsletter at intensivecarehotline.com.

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.

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