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Hi, it’s Patrik Hutzel from intensivecarehotline.com, with another quick tip for families in intensive care. We have a membership for families of critically ill patients in intensive care and you can get access to our membership at intensivecarehotline.com by clicking on the membership link or by going to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day and we answer all questions intensive care related and you can email us your questions.

Now, today, I want to answer a question from one of our members and our member writes an email and just says, “What are some of the markers my dad would need to wean him off the tracheostomy? He’s been off the ventilator for a few weeks now. He’s maintaining good blood oxygen levels. He had three days in a row when he didn’t need much or to be suctioned. Today, he did need suctioning and he has a great cough. It seems like my dad is handling his secretions well, but I’m not sure if he’s had a swallow test at this point or any other results if he has.

We also visited an in-patient rehabilitation center today. That was amazing and visited the 5-star nursing home/ LTAC with short-term acute therapy. What a night and day difference, if you know already. I know you know already, but wow, this is so heartbreaking to see the difference in care my dad would receive and what so many others receive. My mom has already mentioned to the doctors to put in the order for the location we want. Thank you again for all your support.”

So, here’s our response.

Thank you so much for being a member and thanks for your update about your dad. We’re very glad to hear that your dad is making good progress. It’s really very good news that your dad has been off the ventilator for a few weeks now, maintaining good oxygen blood levels. Additionally, there have been consecutive days when minimal suctioning is required, which is also great to hear. Today, suctioning has been done and he has a great cough, and it seems that he is handling his secretions well.

Here are certain criteria that your dad would need to fulfill or maintain for the successful removal of the tracheostomy, also known as decannulation.

1. Have a strong effective cough that can expel secretions to the end of the tracheostomy tube and be able to swallow secretions or saliva.
2. Remain off the ventilator for at least 24 hours.
3. Have a good level of consciousness to allow him to protect his own airway and follow commands.
4. Have stable blood gases and oxygen saturations. Oxygen saturations, generally speaking above 94% on minimal oxygen, usually less than 30% of oxygen as this amount can be delivered with a face mask or nasal prongs.
5. Vital signs in normal range including respiratory rate, less than 20 breaths per minute.
6. Swallow reflex needs to be present so that he will not aspirate secretions, sputum, gastric contents and food.
7. No new lung infiltrates with the recent chest X ray.
8. Able to tolerate cough deflation for 24 hours. Basically, what that means is if the tracheostomy cuff or balloon is deflated, it means the airway is open and he needs to be able to tolerate that.
9. Successfully tolerates the speaking valve for 12 hours or more or has the tracheostomy tube capped for up to four hours.

Once again, if the tracheostomy tube is capped and the balloon cuff is down, that means your dad will be forced to either breathe via his mouth or via the nose. And if that works, that would be really good.

The steps leading up to decannulation include using a speaking valve, capping the tracheostomy tube, and even downsizing the tube itself. The process involves a series of trials to assess his readiness and achieve successful decannulation. It is essential that he is evaluated by the pulmonologist, respiratory therapist, speech therapist, physical/occupational therapist, senior nurse and physician to determine his readiness to ensure that he meets the criteria for tracheostomy removal.

You can also read the following articles from our website at intensivecarehotline.com about tracheostomy removal. “When can a tracheostomy removed?”

Another article that can help is, “Tracheostomy decannulation”. We put the links below this video.

Further to your email you mentioned that you’ve been exploring rehabilitation centers for your father’s care. Look I’m all for me moving people out of ICU as quickly as possible. What I’m not for is getting them in an unsafe place. I think your best bet here is that you are getting your dad decannulated in ICU and then get into rehabilitation but not necessarily LTAC because LTAC is predominantly for patients that have a tracheostomy or a ventilator. So, you are much better off in sending him somewhere without the tracheostomy because then they can follow, then they can focus on physical rehabilitation.

Now, you mentioned 5-star nursing home/ LTAC. Well, I think that is still a very low level and just look up the online reviews of LTAC. There is no such thing as a 5-star LTAC, not from my experience, I just leave it there.

Your dad is in a good place at the moment, get him decannulated and then get him to a rehabilitation facility focusing on physical rehab, not on ventilation and tracheostomy removal. He should have that where he is right now and then he should move on to a rehabilitation facility, bypassing LTAC.

So, I hope that helps.

Now, if you want to become a member of our membership for families of critically ill patients in intensive care where you have access to me and my team 24 hours a day in the membership area and via email and where we answer all your questions about intensive care.

Go to intensivecarehotline.com, click on the membership link or go to intensivecaresupport.org directly. In the membership, we answer all your questions, intensive care related 24 hours a day in the membership area and via email.

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

I have worked in intensive care for over 20 years in three different countries where I have also worked as a nurse unit manager for over five years in intensive care. I have been consulting and advocating families in intensive care for the last 10 years. Just have a look at our testimonial section or have a look at our podcast section so that you can see how we help clients. We have saved lives. I can say that without exaggeration.

I also represent you in family meetings with intensive care teams so that you don’t get walked all over. I have been in hundreds of family meetings with families in intensive care, either when I work in intensive care or now as part of my intensivecarehotline.com consulting and advocacy. I know what’s coming in those family meetings. I assess with you the strategies, I lay out the strategies with you, so that you get great outcomes for your loved ones that you can get best care and treatment. And once again that you are in a position to make informed decisions, have peace of mind, control, power, and influence.

Furthermore, we also offer medical record reviews in real time so that you can have a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure or if you are simply suspecting medical negligence. And all of that, you get 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 or what questions and insights you have from this video.

Thanks for watching.

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

Take care for now.