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Quick Tip for Families in Intensive Care: My Dad’s in ICU with Tracheostomy, ICU Wants to Remove the Tracheostomy Despite the Trach Cuff Up?

If you want to know whether you should agree with the tracheostomy decannulation for your critically ill loved one in ICU or not, stay tuned. I’ve got news for you.

Hi, my name is Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, we are currently working with a member from our membership for families of critically ill patients in intensive care. Our member wrote an email the other day and says,

“Hi Patrik,

I have finally managed to sort out the access to the medical records for my dad and I will hopefully gain access in the next two days and then I will be then passing on to you.

Now, continuing from my last email. So, on Sunday, my dad wasn’t stable. His arterial blood gas showed high levels of lactate being 4 mmol/L, but they had gotten it down to 1.1 mmol/L eventually. They had to send off another blood gas. His breathing was slightly labored, and they had to reinflate the tracheostomy cuff again.

He apparently had a dip in blood pressure in the morning. Then yesterday, I get told besides the diarrhea, which had started now, they have sent off a bowel motion sample. He’s doing better, numbers wise, from his bloods and that they will look at tracheostomy decannulation.

I just said, but he isn’t strong enough, he isn’t stable enough. So, the doctor said his numbers suggest he’s okay. But looking at him, I don’t think he is well enough. His blood pressure is fine now and apparently, he was obeying commands earlier. But when we have seen him, he has just been sleeping, staring and being very weak.

So, they want to go ahead today with decannulation. Please advise me, especially since they told us they will not put the tracheostomy back in again if he needs it. Please advise.”

Thank you so much for sending through your email. Well, about the decannulation, do not agree with it because if they’re not going to recannulate, i.e., put the tracheostomy back in, it is an absolutely no go.

Also, if they’re putting up the cuff again, it also means he’s not ready for it. So, if they were to remove the tracheostomy, it’ll kill him most likely. So, you could only agree to a decannulation if you have in writing that they will put the tracheostomy back in, in case he can’t maintain his own airway.

Also, it also suggests that your dad may have a DNR (do not resuscitate), and you don’t even know about it because otherwise they would need to recannulate him if he can’t maintain his own airway after the tracheostomy removal. I think they are potentially misleading you and setting your dad up to die. It’s very unfortunate but you still have time to turn this around.

Tracheostomy decannulation should only be attempted when your dad or any patient for that matter has met all the criteria and is stable enough to breathe without the assistance of a tracheostomy tube.

He needs to be hemodynamically stable, fully awake, and able to follow commands with a good strong cough and he needs to be able to swallow secretion, saliva, tolerate the cuff deflation for more than 24 hours, pass the tracheostomy capping trial test, with stable arterial blood gases, and good chest X-ray without infiltrates before the tracheostomy is removed.

It is also important that he is evaluated by respiratory physician, pulmonologist, speech therapist, respiratory therapist, OT (occupational therapist), a physiotherapist, et cetera to determine his readiness. More importantly, also determine that the tracheostomy can stay out predictably and that it’s not needing to go back in.

So that means, you should absolutely say no to a tracheostomy decannulation unless you have it in writing and they’re happy to put it back in. Otherwise, the condition that you are describing, they’re just setting him up for failure, which in this situation could literally mean your dad is going to die. He’s going to die a horrible death if he’s going to choke on his own saliva. Think about it. Once again, why would they need to put up the tracheostomy cuff if he was ready for decannulation? They are contradicting themselves.

So, I’m glad you are aware that they’re trying to set him up for failure and that this is potentially a plot to let him die, but I can see you’re onto it and, you can prevent that by simply not agreeing and by getting access to the medical records and by getting a second opinion.

So, that is what you get if you are a member of our membership for families of critical patients in intensive care.

I have worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years. We’ve been consulting and advocating for families in intensive care at intensivecarehotline.com since 2013.

We have saved many lives and changed the trajectory of many patients in ICU in a positive way with our consulting and advocacy here at intensivecarehotline.com. You can verify what I’m saying by going to our testimonial section at intensivecarehotline.com and you can see what our clients are saying, or you can look up our podcast section at intensivecarehotline.com where we have done some client interviews verifying the work that we’ve done saving lives.

Now, if you want to become a member and get help quickly, 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 to help you making informed decisions, have peace of mind, control, power, and influence making sure your loved one gets best care and treatment while they’re in ICU.

I also do one-on-one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through the process and I make sure you manage intensive care teams, so they are not managing you. I also talk to doctors and nurses directly once again asking all the questions that you haven’t even considered asking but must be asked when you have a loved one, critically ill in intensive care. Also, 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 so that you can get closure if you have any questions or if you’re simply suspecting medical negligence, we can help you with that as well.

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.

Also, 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 these videos, share the video with your friends and families.

I also do a weekly YouTube live where I answer your questions live on the show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel or if you are a subscriber to our email newsletter at intensivecarehotline.com.

Lastly, if you want to make a small donation with the super chat button or leave an email or a YouTube message and I will get your emails faster when you make a small donation. I’ve got emails still sitting there from October last year. So, I’m barely keeping up making these videos here.

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.

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