Podcast: Play in new window | Download

Subscribe: Apple Podcasts | RSS

Quick Tip for Families in Intensive Care: When Can My Husband in ICU Have the Tracheostomy Removed? He’s on Room Air 21% But No Swallow Assessment!

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

So today’s tip is another question answered from one of our members. We have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. Just click on the membership link there and you can get access and become a member and have your questions answered as well, or you can go to intensivecaresupport.org directly.

So let’s read out the question from our member who says,

“My husband is tolerating the 21% oxygen well, since yesterday to present, with a tracheostomy. The speech therapist has not done a swallow test in two weeks now. I requested a swallow test today and possible decannulation of the tracheostomy. My husband is still waiting to see the speech pathologist. They seem to be dragging their feet in that direction. They tell us we are about ready for discharge, but the home products are still being ordered. He does well on the passy muir speaking valve and I will try the bolus method today. I am getting the practice of giving him his medications via syringe. What should I do next?”

Now, for context, so this is a member in the U.S. And her husband has been in intensive care for many months now. Initially ventilator dependent with tracheostomy, eventually he came off the ventilator. And as you can see now, he’s “only tracheostomy dependent”. And obviously, she wants him to be decannulated and they haven’t done a swallowing assessment for quite some time. He’s on 21% oxygen which is room air. So the air that you and I are breathing is 21%. Those are all good signs.

However, in order to remove a tracheostomy, certain things need to happen, certain boxes need to be ticked. One of them is to be able to swallow because otherwise, saliva or gastric content might go into the lungs causing an aspiration pneumonia.

So, let’s look at my response.

Thank you so much for your email and update about your husband. I’m really glad to know that your husband has completed 24 hours of 21% oxygen, which is equivalent to room air. If he has less respiratory tract secretions, has normal blood gas results, maintains above 94% of oxygen saturation on the pulse oximeter, has a good and clear chest X-ray, has normal vital signs, is obeying commands, can talk with the speaking valve as well, then the intensive care team might assess your husband and may be planning for a tracheostomy removal or a decannulation.

Have the doctors, nurses and respiratory therapists, assessed his breathing condition? What were their comments and plans? You can ask them about their assessments and their plans for him and ask if your husband is ready for decannulation or tracheostomy removal. For successful tracheostomy removal or decannulation, your husband must have a strong cough that he can expel or spit out or can swallow his saliva or secretions. You haven’t actually commented on that. He must tolerate more than 24 hours or more off the ventilator, which he’s done. He must be alert, awake, good conscious level and can follow commands, stable and has good blood gas results, normal vital signs, no breathing difficulties, good oxygen saturation on the pulse oximeter, 94% and above, present swallow reflex. So he will not aspirate his sputum secretions, food, et cetera. No chest infections, good chest x-rays, successfully tolerating a speaking valve, for more or 12 hours a day and must be evaluated or assessed by the doctors, pulmonologist, respiratory therapist, nurses, speech therapist, et cetera.

Now, also I know your husband has a cuff with a balloon. Now, I know the cuff is still up, the cuff needs to come down, so the balloon needs to be deflated. And then once again, if the balloon is deflated and he starts coughing and spluttering and he’s having difficulty swallowing. It’s a sign that he may not be ready for decannulation.

Also, another test that they can do, if he can tolerate the cuff down, is also keep in mind that they can cap the tracheostomy. So what that means is they more or less block the tracheostomy to check if your husband can breathe through the nose. So those are all tests that they can do.

Now, I know you want to go home and I can understand that. The challenge here is you can’t take your husband home by yourself with a tracheostomy without any help.

Now, the reason I’m saying this is the following, some of you may know we are also operating Intensive Care at Home and you can find more information at intensivecareathome.com. With Intensive Care at Home, we are basically providing a genuine alternative to a long-term stay in intensive care. With that long-term stay in intensive care. We can take patients home with critical care nurses 24 hours a day if they have a tracheostomy, for example, or if they have a tracheostomy and a ventilator or if they only have a tracheostomy. Or if they are BiPAP (Bilevel Positive Airway Pressure) / CPAP (Continuous Positive Airway Pressure) ventilated without a tracheostomy or Home TPN. All of those situations require critical care nurses in the home. With the exception of Home TPN, it requires 24-hour intensive care nurses at home.

With Intensive Care at Home, we are currently operating all around Australia, but we’re not in the U.S. yet. So your option at the moment is to work on the decannulation, which is what you’re doing. But going home with a tracheostomy and a nasogastric tube is doomed to fail unless you have 24-hour intensive care nurses at home. That’s the bad news. 

However, it also sounds to me like your husband is very close of coming off the tracheostomy one way or another. So please keep working on that and we are here to guide you step by step. We’ve helped you to get to this point, and we can help you further.

So also if you want more information about when the tracheostomy can be removed, there are articles and videos that I’ve made around the topic. When can the tracheostomy be removed? Tracheostomy removal criteria. And another article is “What are the signs my dad in ICU can have the tracheostomy removed (decannulation)” So, I have more videos and articles there that are linked towards.

So I hope that answers your question.

Now, if you want to become a member for our membership for families of critically patients in intensive care and you want your questions answered, go to intensivecarehotline.com and sign up for the membership. Click on the membership link or go to intensivecaresupport.org directly.

In the membership, you will 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 and also Intensive Care at Home related.

Now, I also offer one on one consulting advocacy over the phone, via Skype, via Zoom, via WhatsApp, whichever medium works best for you. And I talk to doctors and nurses directly. I talk to you directly and your families, I educate you. I advocate for you. I consult for you and your family member in intensive care so that you can make informed decisions, have peace of mind, control, power and influence. And I ask all the questions you haven’t even considered asking time and time again.

I see that intensive care teams don’t even tell you half of the things that are going on when you have a loved one in intensive care. And it is absolutely crucial that you understand what’s going on that. You understand how asking the right questions will lead to better outcomes. It will give you leverage.

Most intensive care teams are pursuing their own agenda and their own agenda only. And it doesn’t include your agenda. And you’ve probably already seen that, you’ve seen the negativity, you’ve seen the doom and gloom, you need a different perspective. You need a different angle and I can help you with that very, very, very fast.

Now, I also represent you in family meetings with intensive care teams. I have represented so many families with meetings with intensive care teams successfully turned situations around very fast where ICU teams wanted to withdraw treatment. We’ve stopped that successfully. We also avoided tracheostomies for patients in intensive care where they could be weaned off the ventilator successfully. There are many, many success stories. You can look up our testimonial section and you can also look up our podcast section with client interviews.

Now we also offer medical record reviews  in real time so that you can have a second opinion in real time. Please contact us at the intensivecarehotline.com, if you want a second opinion. 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, thank you so much for watching

If you like my video, 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 intensivecareathome.com, and I will talk to you in a few days.

Take care for now.