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Quick Tip for Families in Intensive Care: Can My Husband in ICU Have His Tracheostomy Removed Even Though He Can’t Manage His Secretions Yet? 

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

Today’s tip is about, once again, a question answered from one of our members as part of our membership for families of critically ill patients in intensive care. We have a membership for families of critically ill patients in intensive care here at intensivecarehotline.com. You can find more information on our website or at intensivecaresupport.org. In that membership, you have access to me and my team, 24 hours a day, and we answer all questions, intensive care related.

So, let’s get to the question from one of our members. She has her husband in intensive care initially on a ventilator with a tracheostomy and we managed to guide her through the weaning process of the ventilator. Now, he’s stuck with a tracheostomy, and she wants to know how can the tracheostomy be removed as the next step? He’s now starting to use a Passy Muir speaking valve and she has a lot of questions. I’m just reading out one of her emails that we answered.

“Hi, Patrik and Team,

Secretions for my husband are still very heavy. He completed the effortful swallow exercise with a count of 10 today. The speech therapist says that it’s the doctor’s call to recommend any patch or medications to help with secretions. But they like the patients to manage the secretions on their own. He’s not using anything at this time for secretions. What are your thoughts?”

“Thank you for your update. It seems that he’s adjusting slowly to the Passy Muir speaking valve, but every small step is significant progress.

Assuming your husband is awake and has a strong cough, they can increase the current nebulization frequency and dosage or add nebulization to help control excessive mucus and loosen the secretion so he will be able to expel them easily. It’s also important that he’s sitting upright to prevent aspirations.”

It’s also important that he keeps mobilizing because that’s really the only way to strengthen breathing muscles, help with coughing. The stronger the breathing muscles, the better it is and the easier it is for your husband to cough and to cough up secretions. Coughing up secretions and clearing his airway is going to be very, very important going forward that the tracheostomy can be removed. It’s one of the prerequisites. The tracheostomy can’t be removed really if your husband can’t clear and protect his own airway.

“If your husband has persistent labored breathing during Passy Muir speaking valve or is unable to manage the secretions, the ICU nurse or the respiratory therapist can refer him to the doctor for some pulmonary therapy adjustments. So, another thing you should be looking for is oxygen saturation. How often do they suction the secretions?”

If they suction him every hour, that’s very different compared to if they suction him twice a day. So, in terms of what medications should be used, you could use a mucomyst to loosen up secretions. On the other hand, if there are too many secretions, you could also use medications such as glycopyrrolate or other patches, the scopolamine patch to reduce the secretions.

However, there’s then also the risk that the secretions are too dry and potentially block the airway. So, you have to find the right balance here in order to manage the secretions most effectively.

Now, in the ideal scenario here, of course, you can stay on the Passy Muir valve during the day. He might need a nebulizer here and there. Obviously, they need to change his inner cannula quite frequently. Then, you need to watch for how often they suction. If they don’t suction him and he can cough up his secretions, he’s probably pretty close of having that tracheostomy removed, assuming he continues to pass the swallow test, which I believe he has now. So, the signs are pretty good.

Also, overnight, when he’s not on the speaking valve, make sure he’s getting a humidified oxygen or at least humidified air. So, once again, that secretions don’t dry up and for your husband to continue to cough them up easily, that’s going to be really, really important.

Once again, I can’t stress mobilization enough. Mobilization is the cornerstone really of recovery, especially when it comes to ventilator and tracheostomy weaning.  How are breathing muscles going to strengthen if a patient is lying in bed all day? Very, very, very important. So, I hope that helps.

That is my quick tip for today.

Just last but not least, and if your husband can’t have the tracheostomy removed for whatever reason and he’s stuck in ICU, have a look at intensivecareathome.com. With Intensive Care at Home, we are taking tracheostomy patients home, adults and children with critical care nurses to help improve their quality of life, in some instances, their quality of end of life and also help hospitals and intensive care units to free up their ICU beds.

We are currently operating all around Australia with Intensive Care at Home. We are NDIS (National Disability Insurance Scheme) TAC (Transport Accident Commission), NIISQ, iCare, DVA funded service provider. So, please go to intensivecareathome.com. But even if you’re in another country, U.S., U.K., or Canada, please contact us as well. We can help you with going home as well if that’s what you would like.

Now, if you want to be a member of our membership for families of critically and patients in intensive care, and you want to have your questions answered, go to intensivecarehotline.com.  You can select the section membership on our website, or you can just go to intensivecaresupport.org. There, once again, you get access to me and my team, 24 hours a day, in the membership area and via email and we answer all questions, intensive care and Intensive Care at Home related.

Now, I also offer one on one consulting and advocacy for families in intensive care.  I talk to doctors and nurses directly. I talk to you and your families directly, of course. I talk to you, doctors, and nurses, we can set up three-way calls, we can set up Zoom, WhatsApp, Skype, whichever medium works best for you. I do represent you in family meetings with intensive care teams as well, making sure that all the right questions are asked. I will ask all the questions that you haven’t even considered asking but must be asked so that you can make informed decisions, and have peace of mind, control, power, and influence when you have a loved one in intensive care.

Now, we also offer medical record reviews in real time so that you can have a second opinion in real time. So, please contact us for that as well. We also review medical records after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence.

Now, if you are finding my videos valuable, 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, what questions and insights you have from this video.

Thanks for watching.

This is Patrik Hutzel from Intensive Care Hotline and intensivecareathome.com and I will talk to you in a few days.

Take care for now.

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