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If you want to know if you should give consent to a tracheostomy for your mom or for any other family member after 5 days in ICU for ventilation with the breathing tube due to a brain injury from a cardiac arrest, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care.

So, today, I have an email from John who says, 

“Hi, Patrik. 

I’m reaching out to you in regard to my mother who has been in ICU for 5 days now due to brain hypoxia from a cardiac arrest. Since it has been 5 days, the doctors want us to make a decision by tomorrow or Monday about my mother getting a tracheostomy. 

What would you advise?” – John

Well, John, what I would advise is get on a call with me as quickly as possible, that’s what I would advise, but I can also break it down to you in this video.

So, 5 days in ICU with a breathing tube after cardiac arrest and hypoxic brain injury is not a long time. Now, if you look at the literature and if you look at the research, tracheostomy should be done after about Day 10 to Day 14 after having shown the inability of weaning someone off the ventilator. That cannot be shown after 5 days. Now, there are some exceptions to that rule, but I don’t think that hypoxic brain injury after cardiac arrest is the exception to that rule.

Now, let’s look at a few things before we dig deeper into the tracheostomy issue. 

Number 1. Cardiac arrest and potential hypoxic brain injury in intensive care. Have they done a CT scan of the brain? Have they done an MRI scan of the brain? What does it show? Have you seen it? Do you have access to the medical records? Have they done an EEG (Electroencephalograph)? What is the evidence for your mom that she has hypoxic brain injury from the cardiac arrest, and have you seen the evidence? That’s number 1.

Number 2. Is she still on sedatives and opiates? Most patients in ICU, even with a hypoxic brain injury after cardiac arrest, end up with some level of sedation and opiates even if it’s only for 24 to 48 hours while they are going through cooling therapy, which leads me to my next question.

Has she been in cooling therapy for the cardiac arrest? Is she having seizures, or is she having seizures after the cardiac arrest and the hypoxic brain injury? If she’s not having seizures, does she really have a hypoxic brain injury? In many patients in intensive care after cardiac arrest with hypoxic brain injury do end up having seizures. If she’s having seizures, she might also be on medications such as phenytoin or Keppra, and those also have a sedative effect.

So, my question to you is, is she still too sedated? If she’s still too sedated, they need to get rid of sedation first and foremost. Can she wake up? Can she be weaned off the ventilator?

Now, here’s another thing because I know, John, that you’re in the U.S., here is the biggest issue in the US with doing a tracheostomy early, and Day 5 is very early. Their goal is to send your mom to an LTAC (Long-Term Acute Care Facility or Long-Term Acute Care Hospital) and get her out of ICU as quickly as possible without having treated all the underlying issues that have potentially led to your mom having a cardiac arrest.

Have you spoken to the cardiologist? How can this be avoided going forward? Also, have you spoken to a neurologist to find out what their prognosis is? Do they support doing a tracheostomy after Day 5?

Next, if she is having a tracheostomy now, what are their goals for tracheostomy? Are there goals to wean her off the ventilator in this ICU? Or are there goals to send your mom out to an LTAC facility as quickly as possible? Because if they do that and you give consent to it or you can’t see it coming, you’ve got another thing coming. It won’t be good.

Also, have they asked to do a PEG tube (Percutaneous Endoscopic Gastrostomy) as part of the tracheostomy surgery? If they have, that is also dangerous and not necessary, by the way. A nasogastric tube will do perfectly fine but for the sake of this video, I want to focus on the tracheostomy, or more or less the avoidance of it.

There’s another question.  Are they doing everything beyond the shadow of a doubt to get your mom off the ventilator and the breathing tube and avoid the tracheostomy because they still have another 5 to 9 days before time is up? Why are they rushing to do a tracheostomy? What’s the rush here?

From your email, I’m judging you have no idea that they want to send your mom to LTAC. From your email, I’m also getting that you don’t know that they also want to do a PEG tube, which I believe they do. They may not have mentioned it. They might want you to sign for a tracheostomy first and then they might say to you, “Oh, by the way, we’re also wanting to do a PEG tube.” Just connecting all the dots with all my experience.

Now, what I would do if I was you as a next step, have a look at the article, “How to wean a critically ill patient off the ventilator and the breathing tube?” I encourage you to have a look and read through that. There’s also a video because that is actually the best explanation how to avoid a tracheostomy.

Like I said, John, I very much doubt that doing a tracheostomy after Day 5 is in the best interest for your mom. Tracheostomies have that time and their place. They absolutely do but not when it’s too early, and not if they haven’t tried everything, and I can assure you they haven’t tried everything.

Their agenda is to do a tracheostomy and a PEG tube and ship your mom out to an LTAC facility, which means out of sight, out of mind for the ICU team. It’s very sad, but that’s what it is. You can ignore reality, but you can’t ignore the consequences of ignoring reality. So, keep your eyes wide open, seek advice so that your mom gets best care and treatment always. At the moment, I don’t think she’s getting best care and treatment.

So, I hope that helps.

To add on to it, what they should be doing is weaning her off the ventilator. I would also ask them, why can she not be weaned off the ventilator? What stops her from being weaned off the ventilator? There could also be a scenario where she might need a tracheostomy, but she can still be weaned off the ventilator, and that is if she can’t wake up. So, please keep all of that in mind when taking the next steps, but you really need to seek a second opinion here. You will need to see consulting and advocacy, otherwise, they would be walking all over you and you won’t even know it’s happening.

Because the biggest challenge for families in intensive care is simply 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. That is exactly what you’re up against, but at least you’ve reached out, at least you’ve got some insights now but it won’t be enough to turn this situation around because you really need to have someone that’s either talking to doctors and nurses directly like I do with you or on your behalf, or look at medical records, ideally do a combination of both, so that you can really make the right decision here.

Now, I have worked in critical care nursing for 25 years in 3 different countries, where I worked as a nurse manager for over 5 years in intensive care, and I have been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com.  I can very, very confidently say that we have saved many lives with our consulting and advocacy. You can verify that on our testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done some client interviews.

I can assure you just as is evidenced in our testimonial and on our podcast section that our advice is quite literally life changing. It is life changing. We have improved so many lives and saved lives over the years. That’s why you can join a growing number of members and clients that we have helped over the years. We have helped hundreds of members and clients over the years to improve their lives instantly, making sure their loved ones get the best care and treatment always by making informed decisions, having peace of mind, control, power and influence.

That’s why I do one-on-one consulting and advocacy over the phone, Zoom, Skype, WhatsApp, 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 simply cannot afford to get wrong. I also talk to doctors and nurses directly with you or on your behalf, and I ask all the questions that you have not even considered asking but must be asked when you have a loved one critically ill in intensive care. 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. I also represent you in family meetings with intensive care teams. 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.

We also have a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com, if you click on the membership link, or if you 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 for our members. All of that will help you to make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

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

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Thank you so much for watching this video.

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

Take care for now.