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Quick Tip for Families in Intensive Care: My Husband has Pressure Sores in ICU, Can He have Hyperbaric Therapy even with a Tracheostomy?

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

So, today’s tip is again a question from one of our members. We have a membership for families of critically ill patients in intensive care. You can get access to that at intensivecarehotline.com if you’re clicking on our membership link or if you go to intensivecaresupport.org  directly. Now in that 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.

Now, let’s get to the question from our member who says, “Hi, Patrik and team. My husband has been weaned off the ventilator), but he still has the tracheostomy.” So, this is a member who has her 78-year-old husband in ICU, ventilated with tracheostomy. So, he’s now been weaned off the ventilator.

She continues, “The infectious disease doctor states he has been monitoring his white cell count and they are in the normal range. The first attempt at the swallow test, he did 7. The second attempt at the swallow test, he did 10. I don’t think that the speech therapist is working with him as often as she should.” Now, just for context, when someone is weaned off the ventilator and has a tracheostomy, and then in order to have the tracheostomy removed, they usually need to pass a swallowing test and that’s where our member’s husband is at.

“He now has three wounds on his bottom. Two of them are Stage 3 pressure sore and one is unstageable. The wounds are causing him a lot of pain so he’s on a lot of pain medication for that. He has a wound on his heel that was almost healed when he arrived at the hospital, the wound care nurse states that the heel is not healing as fast as it should, and he should wear his foot boots more often to protect the heel and assist with the healing.

I suggest that he might need some Vitamin C to speed up the healing because at this hospital, they only have the hyperbaric oxygen therapy for outpatients, and he also needs to be mobilized more. His temperature is normal, and his secretions are white. I feel the doctors and nurses are retaliating because my husband refused to get a PEG (Percutaneous Endoscopic Gastrostomy Tube) or go to LTAC (Long Term Acute Care). I spoke to the patient advocate about this yesterday and it seems as if the staff are being more cooperative today.

We are hoping to go home soon with home health care assistance. Thanks for your prompt response.”

Just before we go into a detailed answer, there is hyperbaric oxygen therapy available for ICU patients in some hospitals. I’ve worked in some ICUs where hyperbaric therapy is available in ICU, and you can take ventilated patients to hyperbaric oxygen therapy, doesn’t stop them from going.

Now, let’s look at the answer, “Thank you so much for your question, member.” We are not going to mention names here. “Transitioning to an LTAC should not be done. I would strongly advise against LTAC and advocate avoiding LTAC since there is no adequate clinical care there, let alone superior clinical care specialized in taking care of post ICU patients.”

Just have a look at the online reviews for LTACs on Google. They are pretty atrocious. We recommend families, if they are thinking about LTAC, visit some LTACs, get some family testimonials, and see what they say and then decide. For ICUs, it’s a one-size-fits-all. If a long-term patient or a patient with a tracheostomy and a PEG, the ICUs just want to ship them out as quickly as possible.

This is mainly in the U.S. It doesn’t happen so much in other countries, but it’s mainly a U.S. issue. We strongly advise against LTAC. We have literally families begging us to get them out of LTAC.

Now, in addition, the hospital cannot force you to go to any LTAC without the surrogate or patient’s consent. PEG is usually a requirement for LTAC admission. So, therefore, we don’t recommend a PEG since it will lead him to LTAC. So, the simple thing you need to do in a situation like that is just not give consent to a PEG tube. An LTAC doesn’t take a patient with a nasogastric tube, they can’t manage that. That also should tell you something about the skill level in an LTAC, if they can’t manage a nasogastric tube.

So, that’s what we’ve been saying for nearly a decade here now that if an LTAC can’t even manage a nasogastric tube, how can they possibly manage a ventilated and tracheostomy patient that’s an intensive care skill?

“More significantly, your husband is close to removal of the tracheostomy, he is tolerating nasogastric tube feeding and passing the swallowing test. Thus, he doesn’t need a PEG in the long run anyway. They need to be patient with the decannulation process and hopefully remove the tracheostomy and then the nasogastric tube and allow him to eat by mouth.”

So, it also sounds like he’s halfway there anyway. Why would he go to a place that can’t provide the clinical care he needs? That would be insanity and madness. Most patients in LTAC bounce back to ICU, we’ve seen it over and over again and then they bounce back into another ICU because the discharging ICU no longer has any beds available. Then, he’ll be in three facilities in no time. That is insanity and madness and not what your husband needs.

Your husband needs a stable team around him that knows him and can work with him on a consistent basis until he is improving to the point where he can be discharged, and it soon looks like he’s on his way.

Next, “It seems that the pressure sores are preventing him from mobilizing due to the pain. Giving pain medication should be continued and he needs more than Vitamin C for wound healing. Since he has been glued to the bed for a long time, he experiences his muscle wasting, muscle shrinks and loses his strength. You can still ask for Vitamin C for his immune system, but protein rich food is highly recommended nutritional support to regain muscle mass and help in wound healing. You can follow up with the nutritionist to check his tube feeding and ask for additional protein supplement, if possible. Also, frequent turning and mobilization should also be done by the nurses to keep the pressure off the bed sores.”

Please also keep in mind that if he has pressure sores, that’s medical or nursing negligence because if, as a nurse, you’re doing your job properly and you take the pressure off the body every two hours, give good back washes, sacrum washes, make sure that the heels are up in the air, that they’re not putting pressure on the mattress, a pressure sore should not happen. That is gross negligence.

“Also, is the general surgery on board to check the wounds? Are they recommending debridement for some wounds? What are they doing for wound care?”

I also put some guidance here for you for some other videos that I’ve done in the past quickly for families in ICU, “How to convince the ICU team to not send your loved one to LTAC?” and another quick tip for families in intensive care, “Why there is no clinical support in LTAC?” So, in another quick video, “How to avoid LTAC when your loved one is ventilated with the tracheostomy in ICU? So, I put all the links there. You can check it out.

But just coming back, just to summarize here. It sounds like your husband is more than halfway there for decannulation. They need to sort out the wounds.

Now, also keep in mind, if he goes to LTAC, God forbid, in an ICU or even a step-down ICU, you have 1 to 1 or 1 to 2 nurse-to-patient ratio. Once he goes to LTAC, it’ll be 1 to 4, 1 to 5 potentially up to 1 to 10 overnight. Now, let me ask you this question, how do you think an LTAC can prevent pressure sores or improve pressure sores with the nurse-to-patient ratio 1 to 4, 1 to 5 for someone with a tracheostomy who needs one on one. How do you think they can do that potentially with 1 to 8 or 1 to 10 overnight? If an ICU with 1 to 1 to 1, or 1 to 2 nurse-to-patient ratio can’t prevent pressure sores. I’ll let you think about that.

The answer is crystal clear that if an ICU is negligent and can’t prevent pressure sores, which should be nursing 101. No patient in the hospital should have pressure sores. How can an LTAC prevent that? I’ll leave that with you to answer.

Now, thank you so much for watching.

If you have a loved one in intensive care and you want to become part of our membership for families of critically ill patients in intensive care, go to intensivecarehotline.com, click on the membership link, or go to intensivecaresupport.org directly. There, you get 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 and advocacy for families in intensive care over the phone, via Skype, via Zoom, via WhatsApp, whichever medium works best for you. I talk to doctors and nurses directly with you and I ask all the questions that you haven’t even considered asking because the biggest challenge for families in intensive care is 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’s where I come in.

When I talk to doctors and nurses directly, I make sure you make informed decisions, get peace of mind, control, power, and influence when you have a loved one in intensive care. I also represent you in family meetings with intensive care teams. I’ve been in hundreds of them. I know exactly what’s coming for you and I can make sure that once again you get to make informed decisions, get peace of mind, control, power, and influence and that your loved one gets the best care and treatment.

Now, we also review medical records in real time so that you can have a second opinion by you and me talking to the doctors and nurse directly but it’s often the best option when we combine that with a medical record review. We also review medical records after intensive care if you have unanswered questions, if you’re looking for closure, or if you’re simply suspecting medical negligence.

Now, if you like my videos, if you find value in them, 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 or what questions and insights you have from this video, and share the video with your friends and families.

Thanks for watching.

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

Take care for now.

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