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

So today, I want to read out an email from one of our members that we worked with over the last few months just to illustrate once again how important it is that you do not let your loved one go from ICU to LTAC. This is again for our U.S. audience because LTAC only exists in the United States. LTAC stands for Long-Term Acute Care hospital or Long-Term Acute Care facility.

Just to recap, many patients in intensive care in the U.S. that end up with a tracheostomy and PEG end up in LTAC because families don’t know any better that’s not a good way to go because we have desperate families reaching out to us and trying to help them to get their loved ones out of LTAC. So that’s the context.

Let’s read out the email from our member Heather who says,

“Hi Patrik,

The problem is that he was not on a ventilator when he went from ICU to LTAC. He aspirated in this LTAC and then needed to be put on a ventilator there.

He was on it for three weeks, then he had the tracheostomy procedure on the 14th of February in 2024. He has progressed now to doing the T-piece, the T-bar which is unplugged from the ventilator and he’s breathing spontaneously with the T-piece just with humidified oxygen or air. He can do that for 9 hours per day. He’s on the ventilator at night.

The day after the operation, his blood pressure and heart rate shot up in the evening. The nurses called the doctor and the cardiologist, and the levels brought down with medications. Now, he’s back on a low dose of aspirin and the blood pressure medication (BP) had not been high since before his hospitalization for suspected COVID in December. He was treated for that only and we found out later that no wound dressing was changed, and wounds were reinfected, causing him to be readmitted to a different hospital, three days later with septicemia.

He has had periodic bouts of elevated heart rate up to 165 beats per minute. They have given him either Lorazepam or morphine depending on whether they think the heart rate is related to pain or anxiety. My father was able to use the Passy-Muir speaking valve yesterday and verbalized that he was in pain and his throat hurts, but he only has the valve during speech therapy for now.

He was supposed to see a foot and ankle surgeon for a consult on Friday, but they didn’t show up. He is being seen by the infectious disease doctor and wound care. They have pumped up changing the dressings on the right heel to daily.

I was able to get some printouts of the doctor’s orders only up until the 20th of February and I received them yesterday.

Obviously, this is an email from earlier in the year.

The office has now told me they will not give us access to anything else that they consider our records (nurse notes, procedure notes, doctor’s orders, doctor progress notes) until my dad leaves. I will try to go through the huge stack of paper I was given yesterday to see the most recent diagnosis and medication.”

So, few things. This is what happens when you have your loved one, go from ICU to LTAC. There’s absolutely no need for that. I’ve made countless videos over the years that when patients go from ICU to LTAC and it’s basically a disaster area waiting to happen.

So, let me illustrate this. Once again, LTACs are not equipped to look after ventilated patients or patients with airway issues because (A) the success rates of LTAC weaning patients off the ventilator and the tracheostomy are pretty low. Check out your local LTAC and have a look online or on the Google reviews and see what families actually say about those LTACs. That should tell you everything that you need to know.

Furthermore, I’ve done a video a few weeks ago, a YouTube livestream, “10 reasons why LTACs in the U.S. are a scam”, and I stand by that video, and I mean every word that I said in that video. So have a look, we’ll link towards that video below this video today.

Then, at least he’s making some progress, and this is not documented in this email but because we’ve worked with the member closely, her dad also ended up with severe Stage 3 and Stage 4 pressure sores in that LTAC. This is the level of care you can expect in an LTAC, patients not being able to wean off the ventilator, no physical therapy ending up with pressure sores.

The best place for a ventilated patient is ICU, unfortunately, or the alternative to ICU is Intensive Care at Home. You can find more information at intensivecareathome.com.

Now also, if he had high blood pressure, low blood pressure, his hemodynamics have been all over the place and LTAC definitely isn’t the right place to be. When you look at the bigger scheme of things in LTAC, you don’t find ICU nurses and yet the nurses there are supposed to look after patients on ventilation with tracheostomy and they’re supposed to do the work that ICU nurses and ICU doctors are doing. The other issue in LTAC is there’s often not doctors on site, 24 hours a day, which is of significant concern as well.

So, just to recap as well, I’ve mentioned this in other countless videos, if your loved one is in intensive care, they may need a tracheostomy but do not give consent to a PEG tube. There’s no need for a PEG tube.

Patients can perfectly have a nasogastric tube for up to 6 months and even longer because PEG tube requires surgery, it’s another surgical procedure and a nasogastric tube doesn’t require surgery.

Also, if you don’t give consent to a PEG whilst your loved one is in ICU, there’s a higher chance the ICU can’t send your loved one to an LTAC because LTAC, generally speaking, don’t take patients without a PEG tube. That should tell you everything about the skill those LTAC offer. If they can’t look after a nasogastric tube, that should tell you everything about the skill that you’re getting in an LTAC. If they can’t look after a nasogastric tube, how can they possibly look after someone on a ventilator on life support? So, just keep that in mind as well.

I will also link below this video to a research paper that says nasogastric tubes are better than PEG tubes and cause less harm. So, there’s research out there to confirm what I’ve been saying on my blog here for the last 10 years or so.

For anyone watching this blog for quite some time, you would have seen me make videos and blog posts around the tragedies that happened in LTAC in the United States. Your best way forward if you have a loved one, critically ill in intensive care in the U.S. is a tracheostomy can be the right thing to do, but definitely not a PEG tube.

Also, with a PEG tube, to reiterate, a PEG tube gives the impression and perception that it’s a permanent tube, and that patients will never eat and drink again, and that nutrition will happen via the PEG tube. That’s the perception in healthcare.

Whereas a nasogastric tube, the perception is always that it’s temporary. So, efforts need to be made to wean someone off a ventilator and get them to eat and drink again. Just on this reason alone, you should never give consent to a PEG tube. It should be temporary. Mechanical ventilation, tracheostomy should be temporary. It should not be permanent.

But before you even give consent to a tracheostomy, you got to ask very important question, what is the ICU doing to avoid the tracheostomy? What are they doing to try and wean your loved one off the ventilator and the breathing tube beyond the shadow of a doubt?

Because if you don’t ask those questions that’s when you end up in situations like how a member ended up in here. By not doing the research right from the start, that’s when things like that go pear shaped.

So, I hope that helps you understand, once again, the importance of doing your research from Day 1, having a loved one critically ill in intensive care is a once in a lifetime situation that you can’t afford to get wrong, and you can’t afford not to do your research from ground zero, from Day 1.

I have worked in critical care nursing for nearly 25 years in three different countries where I’ve worked as a nurse manager for over 5 years and where I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. We have saved many lives with our consulting advocacy. You can verify that on our testimonial section or on our podcast section at intensivecarehotline.com where we’ve done client interviews.

That’s also one of the reasons why we created a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, click on the membership link or 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.

In the membership, you also have exclusive access to 21 e-books and 21 videos that I have personally written and recorded, giving you access to all of my two and a half decades worth of ICU nursing experience, making sure you make informed decisions, have peace of mind control, power, and influence so that you can influence decision making fast, even if you’re not a doctor or a nursing intensive care, making sure your loved one gets best care and treatment.

I also do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, Skype, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once in a lifetime situation that you can’t afford to get wrong. I also talk to doctors and nurses directly. I ask all the questions that you haven’t even considered asking. I also represent you in family meetings with intensive care teams.

We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or send an email to [email protected] with your questions.

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, comment below what you want to see next, what questions and insights you have from this video, share this video with your friends and families.

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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.