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

So, today’s tip is, again, a series of questions we are answering from one of our members who is part of our membership for families of critically ill patients in intensive care. You can get access to that membership by going to intensivecaresupport.org and you can become a member there.

I’ll get to the question of our member now, “Hi, Patrik and team. What are some of the markers my dad would need to make him wean off the tracheostomy? He’s been off the ventilator for a few weeks now. He’s maintaining good blood oxygen levels. He had three days in a row where he didn’t need much to be suctioned very often.

Today, he did need suctioning and he has had a great cough. It seems like my dad is handling his secretions well, but I’m not sure if he’s had a swallow test at this point or results if he has. We visited an inpatient rehabilitation center today, that was amazing and visited the five-star nursing home with the short-term acute therapy, night, and day difference.

I know you already know this. But wow, this is so heartbreaking to see the difference in care my dad would receive and what so many others receive by leaving ICU. My mom has already mentioned to the doctors to put in the order for the location we want. Thank you again for all your support.”

So now here’s the answer, “Hi, thank you for your email and updates. We’re really glad that your dad is making good progress. It’s really good news that your dad has been off the ventilator for a few weeks now, maintaining good oxygen blood levels. Additionally, there have been consecutive days when minimal suctioning is required, which is also good. Today, suctioning has been done and he has had a great cough and it seems that he’s handling his secretions well.

Here are the criteria that your dad would need to fulfill or maintain for a successful removal of the tracheostomy, also known as decannulation.

Number 1, have a strong effective cough that can expel secretions to the end of the tracheal tube and be able to swallow secretion, saliva, or spit them out. Number 2, remain off the ventilator for at least 24 hours a day. Number 3, have a good level of consciousness to allow him to protect his own airway and that he can follow commands. Number 4, have stable blood gases and oxygen saturations, ideally, oxygen saturations above 94%. On minimal oxygen, usually less than 30% oxygen as this amount can be delivered with a face mask or nasal prongs. Number 5, vital signs in normal range including respiratory rate, less than 20 breaths per minute. Number 6, swallow reflex needs to be present so that he will not aspirate secretions, sputum, gastric contents, and food. Number 7, no new lung infiltrates per recent chest x-ray. Number 8, able to tolerate cuff deflation for 24 hours. Cuff deflation means that the tracheostomy balloon/ tracheostomy cuff has no air in it. Number 9, successfully tolerate a speaking valve for 12 hours or more or have the tracheostomy tube capped for up to four hours.

The steps leading up to decannulation include using the speaking valve, capping the tracheostomy tube, and even downsizing the tracheostomy tube itself. The process involves a series of trials to assess his readiness and achieve a successful decannulation.

It is essential that he is being evaluated by the pulmonologist, speech therapist, respiratory therapist, ICU doctor, and by the physical and occupational therapist to determine his readiness and ensure that he meets the criteria for tracheostomy removal, also known as decannulation.”

I’ve also written an article about this and made a video about it, “When can the tracheostomy be removed?”. I will link to what’s that article and video below this video. I hope that is a good quick tip for today.

Now, if you have a loved one in intensive care and you want to become a member for our membership for families of critically ill patients in intensive care, go to intensivecaresupport.org. There, you can get access to the membership where 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.

I also offer 1:1 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 on your behalf, asking all the questions that you haven’t even considered asking but are vital for your loved one to get best care and treatment, and that’s how we can give you a second opinion in real time and very, very fast.

I also represent you in family meetings with the intensive care team. I have done so for hundreds of our clients with very good outcomes. We have been saving lives here at intensivecarehotline.com over many years by knowing about how ICUs operate, by knowing about treatment options, by knowing about patient and family rights. I have worked in intensive care for over 20 years in three different countries where I also worked as a nurse unit manager for over five years. So, I know the ins and outs of how ICU operates. We’ve been consulting and advocating for clients all over the world in ICU for the last 10 years.

We also offer medical record reviews in real time so that you can get a second opinion in real time. Please contact us 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]. Also, we review medical records after intensive care if you have unanswered questions, if you need closure, or if you are simply suspecting medical negligence, please contact us as well.

If you are finding my videos valuable, subscribe to my YouTube channel, 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.