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Quick Tip for Families in Intensive Care: Should My Mother Have a Tracheostomy After 2 Weeks on a Breathing Tube After PE (Pulmonary Embolism)? 

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

So, currently, we are working with a client who has a 74-year-old mother in intensive care. Our client’s mother had a car accident about 14 – 15 days ago. She had a pelvic fracture, initially went into hospital, but then developed a PE (Pulmonary Embolism) and went into cardiac arrest. At the time, she was in cardiac arrest for nearly 40 minutes and despite all of that, she seems to have no brain injury. So, the CPR (cardiopulmonary resuscitation) must have been really, really effective, and they must have done a great job to resuscitate this lady.

Anyway, when the client first reached out to us, and we were starting to work with them, the intensive care team told the client that her mom would need a tracheostomy because she can’t wean off the ventilator. The best next step would be to perform a tracheostomy to help her wean off the ventilator and she wasn’t sure whether that was the right thing to do or whether she’s potentially being misled, or she simply wanted a second opinion for peace of mind, making informed decisions, have control, power, and influence.

I then spoke to the intensivist at the hospital, and it turned out that a tracheostomy was most likely the right decision to make because the lady didn’t cough. The client’s mother have no cough reflex, no gag reflex, was breathing on minimal support from the ventilator in a CPAP and pressure support ventilation mode – minimal support, 35% FiO2 (fraction of inspired oxygen). Arterial blood gases were good, chest x-rays were good despite having had rib fractures as well as part of the motor vehicle accident.

She was obeying commands, she was squeezing hands, was poking out her tongue, opening eyes. She was doing all the right things, but simply couldn’t cough or gag, which is obviously, something that needs to happen, a reflex that needs to be there because otherwise, when you take out the breathing tube and someone can’t cough or gag, they can’t protect the airway and they end up with the breathing tube back in, in no time. So, we all felt quite confident that a tracheostomy was the right next thing to do.

It turns out that the ICU was really good in terms of mobilizing our client’s mother early on even before I had the call. They kept doing that and then all of a sudden, just on the day as they were doing meant to do the tracheostomy, she started coughing. Isn’t that interesting? So, she started coughing on the day when they were planning the tracheostomy and then they were holding off for another day just to see what would be next and that was just yesterday. So, I’m waiting for another update to see whether tracheostomy can be avoided or not. But that’s how it should be.

This is a really good example that this is an ICU that’s doing all the right things and is having the patient’s best interest at heart, not wanting to shift out patients to LTAC (long-term acute care). This is not an ICU in the U.S., but never mind. Not like in the U.S. where people get tracheostomy so they can shift people out to LTAC. So, this is an ICU that really seems to have the lady’s best interest at heart. So, that’s really good news.

Also, you should keep in mind that you always need a second opinion. You can’t just follow blindly what intensive care teams are doing and we can help you with that very, very quickly.

So, that is my quick tip for today.

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

Also, I offer one-on-one consulting and advocacy for families in intensive care over the phone, via Skype, via WhatsApp, via Zoom, whichever medium works best for you. I talk to doctors and nurses directly. I ask all the questions you haven’t even considered asking but must be asked so that you can make informed decisions, have peace of mind, control, power, and influence. I also represent you in family meetings with intensive care teams so that you have clinical representation as well as advocacy representation.

We also have a membership for families of critically ill patients in intensive care. 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. You can get access to our membership for families of critically ill patients in intensive care at intensivecarehotline.com by clicking on the membership link or by going to intensivecaresupport.org directly.

Also, we offer medical record reviews in real time so that you can have a second opinion in real time. So, contact us as well if you want a second opinion with a medical record review. We also offer medical record reviews after intensive care if you have unanswered questions, if you are needing 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, share the video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

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.