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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 another frustration that one of our readers, John, has shared and he says, “Hi Patrik, I have been asked to move my father to a long-term care facility with an ICU because we are only Day 6 of intubation and he’s making progress in weaning off. They want to do a tracheostomy and the PEG (Percutaneous Endoscopic Gastrostomy) and want to send him to LTAC. After watching all your videos, it sounds to me like that might be unnecessary. Can you please shed more light on this?” Absolutely, John, thank you so much for sharing your dad’s situation. Obviously, John is in the U.S. because LTAC is very specific to the U.S., long-term acute care is what LTAC stands for.

Now, here’s the deal. Many patients in intensive care that end up on a ventilator with a breathing tube and can’t be weaned off after Day 10 to Day 14 might need a tracheostomy. Now, they definitely don’t need a picture, but I’ll come to that in a minute.

So, what should John do here? Well, the Number 1 goal for any patient in intensive care to wean off the ventilator with a breathing tube, which should be the number one goal. If he’s making progress, why would they even start talking about sending him to an LTAC? That sounds to me like they’re not acting in the best interest of John’s father. It sounds like they’re acting in the best interest of the hospital, which is to make as much money as possible and then send the patient out as quickly as possible so they can get the next profitable patient in where they can make a lot of money rather than focusing on weaning John’s dad off the ventilator and doing the right thing and avoiding the tracheostomy.

Now, they’re already trying to set him up for an LTAC. LTAC, once again, stands for a Long-Term Acute Care facility. Once a patient in intensive care in the U.S. with a tracheostomy had a PEG tube, they often get sent to LTAC facilities.

LTACs are not even the better version of a nursing home. They are places that need to be avoided at all costs. The best place to wean a patient off the ventilator is intensive care because you have intensive care doctors, intensive care nurses, you have respiratory therapists, you have a whole multidisciplinary team that is well equipped to wean patients off ventilation.

Now, in this day and age, it looks like most ICUs in the U.S. are now going down the track of doing a tracheostomy and a PEG tube and sending patients to LTAC, not for clinical reasons but it’s mainly to manage their beds, their bed flow in ICU, empty beds, maximize profit, maximize revenue, and then send patients out. That’s the unfortunate reality of the situation.

Now, here’s how you can counteract this. Don’t give consent to a PEG tube under no circumstances. A tracheostomy might be the right thing to do. A tracheostomy has its time and its place, but if your dad is making progress, it sounds to me like he’s halfway there and they should be able to take the breathing tube out in the next few days.

Now, you haven’t shared why your dad is in ICU. That would certainly be helpful to share that information with us, but in either case, if he’s making progress, you should be able to wean off the ventilator and the breathing tube.

Now, I also have written an article, “How to wean a critically ill patient off the ventilator and the breathing tube?” and you can check that out. I have put the link below this video.

Now, here’s another thing you’re saying that the LTAC, the long-term acute care facility, has an ICU attached. Well, if your dad is well enough to go to LTAC, supposedly, why would they even need an ICU there? Why can’t he stay where he is? Why can’t they finish the job? Why would you send someone with a critical illness to another facility? That sounds like it’s not in the best interest of John’s father here. Just keep that in mind. Just for reference, just have a look online and Google reviews for LTAC facilities. That’s probably telling you everything you need to know.

But in order to put a stop to it one way or another, (A) get them to push for extubation. If you don’t know what signs to look for, you can reach out to us and we can help you with our consulting and advocacy service, making sure that your dad gets best care and treatment, making sure that you make informed decisions, have peace of mind, control, power, and influence in a situation like that.

But don’t give consent to a PEG if your dad does need to tracheostomy because LTACs can’t look after PEG tubes and your dad will be perfectly fine with the nasogastric tube. I’ve made videos about, “PEG tube versus nasogastric tube”  and “Why to avoid a PEG tube at all costs?”

So, that is my quick tip for today.

We have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. You get access to our membership for families of critically ill patients in intensive care at intensivecarehotline.com by you clicking on our membership link or 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.

I also offer one-on-one consulting advocacy for families over the phone, via Zoom, Skype, WhatsApp, whichever meeting works best for you. I talk to you and your families directly. I talk to doctors and nurses directly and I make sure that I asked the questions that you haven’t even considered asking but must be asked.

I’ve worked in intensive care for over 20 years in three different countries where I also worked as a nurse unit manager for over five years in intensive care. I have been consulting and advocating for families in intensive care for the last 10 years as part of my intensivecarehotline.com consulting and advocacy service.

Now, I also represent you in family meetings with intensive care teams so that you have clinical representation, that you have a strong advocate there, so that they don’t take advantage of your inexperience, and that they don’t take advantage of you haven’t worked in ICU. You don’t know the clinical ins and outs of intensive care. You need to have strong representation in family meetings with intensive care teams.

Now, we also offer medical record reviews in real time so that you can get a second opinion in real time so that you can make informed decisions, have peace of mind, control, power, and influence. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

For any of it, please contact us 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].

Now, 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, share the video with your friends and families, and comment below what you want to see next and 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.

Take care for now.