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Quick Tip for Families in Intensive Care: My 90-Year-Old Mother Had CPR (Cardiopulmonary Resuscitation) & Strokes. She’s in ICU, Ventilated. Can She Have a Tracheostomy?

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

Today’s tip is about an email that I had from one of our readers, Sarah, who says, “My mom is 90 years old, she’s in ICU and she’s been on a ventilator for seven days with a breathing tube. The doctors are recommending not to do a tracheostomy due to her having previous strokes and 13 minutes of CPR (cardiopulmonary resuscitation). And they’re saying, she’s too old to have a tracheostomy. What should I do?”

Well Sarah, thank you so much for sharing and for asking that question because I think this is a really important question for other viewers, as well. They’re probably finding themselves in a similar situation if they have a loved one in intensive care with elderly parents. So, let’s just quickly look at the situation.

A lot of it comes down to, let’s say your mom has an advanced care plan, is there a living will? A living document that is clearly documenting what your mom wants in a situation like that. Does she want everything to be done? Does she want to limit her opportunities in a situation like that where she says, no, I don’t want to have a tracheostomy, don’t want to have a ventilator? That’s the first thing.

If that’s the case, then it’s clear cut that you should be going with your mom’s wishes. If it’s not clear cut and there is no living will, no advance care directive, then it comes down to, have you ever had a conversation with your mom about this? If you had a conversation, then you should be guided again by the conversation you’ve had with your mom for a situation like this. If that’s not the case, then you should be going to what you and your family feel is the right thing to do for your mom based on her wishes, her beliefs, her personality. Is she religious? Is she pro-life in a situation like that? Would she be positive? Would she be negative? You have to consider all these facets. It’s not a black or white situation, and it’s not a one size fits all situations either.

A lot of it depends again on values, on ethics, on morals, on your own beliefs. And then a lot of it comes down to as well to, how far are you prepared to go caring for her? Let’s just say she does need a tracheostomy. Let’s just say, she can’t come off the ventilator in the long run, how much work are you prepared to do with your family? Have you considered home care? There are now services like Intensive Care at Home. You can find more information at intensivecareathome.com.

So, you have to think this through carefully and if she’s been on a ventilator for seven days, you still have a few days left. If she can’t come off it, usually the timeline to do a tracheostomy is around Day 10 to Day 14. So, you still have a little bit of time. A lot of it also depends on, what ventilation settings is she on? Can she come off the ventilator? Does she not need a tracheostomy? You have given me very important information, but you’re only scratching the surface here. For example, what I would want to know is what ventilator settings is she on? What are her arterial blood gases? What does her chest X ray look like? What medications is she on? Is she hemodynamically stable? Is she waking up? What’s the MRI scan of the brain showing? What’s the CT scan of the brain showing? Has she had an EEG? What’s the neurologist report saying? So, it’s a multifaceted approach that needs to be taken where you have to take many, many things into consideration.

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. And that is once again exactly what you are dealing with here, Sarah. So, I hope that helps.

And that is my quick tip for today.

Now, if you have a loved one in intensive care and you need help, we actually have a membership for families of critically ill patients in intensive care and you can get access and become a member in our membership when you go to intensivecarehotline.com and you click on the 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 a membership area and via email and we answer all questions intensive care related. In the membership, you also have access to extra eBooks and extra videos that are not publicly available that are specifically targeted towards the needs of families of critically patients in intensive care.

I also offer one on one consulting advocacy for families in intensive care. I talk to you on the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I also talk to doctors and nurses directly asking all the questions that you haven’t even considered asking but must be asked so that you make informed decisions, have peace of mind control, power, and influence.

I also represent you in family meetings with intensive care teams so, once again, that you have advocacy and clinical representation so that you can counteract whatever the intensive care team is throwing at you, and that you have someone on your team that understands intensive care inside out just as much as they do. But I understand it even more so from a family perspective and not just from a hospital perspective, I understand both intimately.

We also offer medical record reviews in real time. If you need a second opinion in real time, please contact us for that. We also offer medical record reviews after intensive care if you need closure, if you have unanswered questions or if you are suspecting medical negligence. One way or another, we can help you and you get all of that at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].

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, what questions and insights you have.

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.