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

So, today’s tip and question answered is from actually one of our members who asked the following question, “Biphasic Cuirass Ventilation: I had requested a note from the ICU team for BCV ventilator as an alternative to a tracheostomy for my husband. I was told this is not the standard of care and they only use it for ALS (Amyotrophic Lateral Sclerosis) patients or MND (Motor Neuron Disease) patients. What are your thoughts on this?”

My thoughts on this are that BCV is not a standard therapy for ventilation. It was a very outdated mode of ventilation in the early days of mechanical ventilation, also known as the iron lung. This has gone through various innovations, of course, and it looks very different today. But the principle is still what the iron lung was in the 1960s.

So, from my experience, it is not an alternative to a tracheostomy because your husband with the BCV would have to be attached to a ventilator that goes all around his tummy, and that’s probably not a good alternative for mobilization and so forth.

So, I do remember, from what I read with the BCV or the iron lung, it was used for polio patients in the 1960s. So I don’t think it’s an alternative in this day and age. There are better alternatives out there, but I’m also not the expert on it. I’m just gathering my thoughts from what I read about it, and it doesn’t sound to me like it is an alternative to a tracheostomy.

Now, let me clarify the alternative to a tracheostomy, which is a much better one. The alternative to a tracheostomy is to get your husband off the ventilator and avoid the tracheostomy and have the breathing tube removed. Now, that can only be done by reducing sedation and opiates early and consistently. It can only be done by mobilizing your husband and doing physical therapy. The longer your husband stays in bed, and is not getting mobilized with a breathing tube, and he is not getting woken up, and is not getting stimulated, the higher the chances are for a tracheostomy.

Now, I have written an article and made a video about “How to wean a critically ill patient of the breathing tube?” and I encourage you to check out that article.

Now, furthermore, I’ve also done a podcast a couple of months ago with Kali Dayton and I can link to that as well. And Kali says that in one ICU she worked in, I believe in the Midwest in the U.S., they never sedated patients while they were on the breathing tube. And she says that they very rarely did a tracheostomy because they mobilized early, they never use sedatives, they never used opiates.

Now, if you think I’m making this up, I’ll encourage you to check out the podcast with Kali Dayton that I’ve done. She’s got amazing insights to share and you will see that BCV is not needed as an alternative and it’s probably not appropriate. So there are other methods to avoid the tracheostomy.

Now, there are situations where a tracheostomy is the right next thing to do. And for example, for spinal injury patients, for neurological patients such as MND or ALS. There are situations where a tracheostomy is the right thing to do. But before you sign up for a tracheostomy, you need to make sure the intensive care team has done everything beyond the shadow of a doubt to wean your husband off the ventilator and the breathing tube. So I hope that helps.

If you want to become a member, I encourage you to check out our membership for families in intensive care at intensivecaresupport.org. There you have access to me and my team 24-hours a day in a membership area and via email and we answer all questions intensive care related.

I also offer one on one consulting advocacy over the phone, via Skype, via email, via Zoom, WhatsApp, whichever medium works best for you. And I talk to the doctor directly with you and on your behalf. I can represent you in family meetings with the intensive care team so that you have that critical third-party oversight that can give you the lay of the land that is non-biased and that actually has the real best interest of your family member at heart.

We also offer medical record reviews in real time. So contact us if you need a medical record review in real time. We also offer medical record reviews after intensive care if you have unanswered questions. If you need closure or if you’re simply suspecting medical negligence, please contact us at intensivecarehotline.com. Call us on one of the numbers at the top of our website or simply send us an email to [email protected].

Now, if you like this video, subscribe to my YouTube channel, click the like button, click the notification bell. Comment below what you want to see next and what questions and insights you have from this video. Share the video with your friends and families.

This is Patrik Hutzel from intensivecarehotline.com, and I’ll talk to you in a few days.

Take care.

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