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Quick Tip for Families in Intensive Care: Should My 88-Year-Old Dad Have a Tracheostomy and Go to LTAC or Should He Stay in ICU with Pneumonia?

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

So yesterday, I was talking to a client, who has their 88-year-old dad in the ICU in the United States. And her dad has been in ICU for about 13 days now, with pneumonia. And according to the client, her dad can’t be weaned off the ventilator. And now ICU is saying, he needs to have a tracheostomy, and he needs to have a PEG and then he needs to go to LTAC to be weaned off the ventilator there. She also asked, what are the options with Intensive Care at Home? And I’ll come to that in a minute.

So, let’s just say you are facing a situation like that, what should your approach be?  Well, your approach should be. First of all, is it true that he can’t be weaned off the ventilator and avoid the tracheostomy?

Now, I wouldn’t know without looking at the medical records or without, talking to doctors and nurses directly looking at ventilator settings, chest x-rays, arterial blood gases, medications he’s on, blood results, giving me a whole overview of the whole situation. Only then can I say, whether is it accurate that he needs a tracheostomy or not. Because what a lot of ICUs do in the U.S. in particular, they’re doing a tracheostomy and then prematurely discharging patients into LTAC.

Now, LTAC stands for Long Term Acute Care facility and it is very specific to the U.S. LTACs don’t exist in other countries. Anyway, what should the client be doing in a situation like that?

Well, first of all, she needs a second opinion, which is what we’re doing now. And to make sure the ICU is acting in the best interest of her dad, because if they’re doing a tracheostomy and the PEG (Percutaneous Endoscopic Gastrostomy) tube purely for the reason to get him to LTAC, that’s not in the best interest of her dad. It’s in the best interest of the ICU.

Now, the ICU’s goal needs to be, to get her dad off the ventilator as quickly as possible. Regardless of whether he needs a tracheostomy or not. Weaning off the ventilator still needs to happen.

Now, spoiler alert. If her dad goes to LTAC, he won’t be weaned off the ventilator because LTAC simply can’t wean people off the ventilator. Look at the LTAC reviews online, just to verify what I’m saying here that I’m not making it up. Just have a look online at LTAC reviews, and then you can connect the dots and you can connect it back to here, what I’m saying.

They are not in a position to wean ventilated patients with tracheostomy off the ventilator. They, as a matter of fact, let patients wither away in the bed for weeks and months. And then, the next step is they send them to a nursing home going from bad to worse. So just keep that in mind.

Now, also, in order for your dad not to go to LTAC another tip here is, do not give consent to a PEG tube under any circumstances. Because if your dad doesn’t have a PEG tube, he won’t go anywhere because an LTAC can’t take a patient without a PEG tube. That should tell you everything that you need to know about the skill level that you can expect in an LTAC if they can’t look after a nasogastric tube which would be, the other alternative for someone instead of a PEG.

So always get a second opinion. That’s very important that you get a second opinion. Don’t be swayed by the plan of ICUs wanting to send patients out to LTAC as quickly as possible.

Now, the lady also asked what’s the option with Intensive Care at Home? Now, Intensive Care at Home is an option if you are long-term ventilated with a tracheostomy. However, your dad has only been in ICU for two weeks. He’s not long-term ventilated at this stage. Again, the ICU needs to try to get your dad off the ventilator as quickly as possible, either with a breathing tube or with a tracheostomy and get him to rehabilitate. That should be the goal.

The goal should not be LTAC, the goal in this situation should not be Intensive Care at Home. Intensive Care at Home is for patients that are long-term ventilated for many weeks, many months sometimes. That’s when they can go home or also in palliative care situations. But you didn’t mention anything about palliative care for your dad.

So, currently with Intensive Care at Home, we are operating all around Australia. So if you have a loved one in intensive care, long-term, ventilated, with a tracheostomy, please contact us here at intensivecareathome.com, and call us on one of the numbers on the top of our website. But also contact us if you are in the U.S. or in the U.K., we can help you one way or another. So that is my quick tip for today.

I hope that helps you understand how to navigate the landscape. When you have a loved one in intensive care, always get a second opinion. Don’t just run with the intensive care team’s suggestions blindly, you need to do your research. You are in a once-in-a-lifetime situation that you can’t afford to get wrong. We have so many families coming to us when it’s too late. They say, “Oh if I only had known that there’s a consulting and advocacy service for families in intensive care”. Don’t be that family. Get help.

So that’s my quick tip for today.

If you have a loved one in intensive care and you need help, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected]. 

Also, we have a membership for families in intensive care at intensivecarehotline.com. Click on the membership link or go to intensivecaresupport.org directly. In our membership for families of critically ill patients in intensive care, 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, I also offer one on one consulting and advocacy over the phone, via Skype, via email, via WhatsApp, via Zoom, whichever medium works best for you. And I talk to doctors and nurses directly ask the question. And I ask all the questions you haven’t even considered asking, but you must ask so that you have peace of mind, control, power, and influence and so that you can make informed decisions. Very, very important.

I also talk to you and your families. I arm you with all the questions that you need to ask if you don’t want me to ask them on your behalf. I also represent you in family meetings with intensive care teams. Don’t go into family meetings without representation from a professional advocate like myself. You need to know what’s coming in those meetings and you need to know how to position yourself and you need to know how to manage intensive care teams so that they don’t manage you.

Now, we also offer medical record reviews in real-time so that you can get 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.

Now, 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 and what questions and insights you have from this video.

Thanks for watching.

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

Take care for now.