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Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we INSTANTLY improve the lives of Families of critically ill Patients in Intensive Care, so that you can make informed decisions, get PEACE OF MIND, real power, real control and so that you can influence decision making FAST, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from our readers and the question last week was
How long does a cardiac arrest patient stay in Intensive Care?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer another frequently asked question by our dear readers at INTENSIVECAREHOTLINE.COM
HOW LONG SHOULD A PATIENT BE ON A VENTILATOR BEFORE HAVING A TRACHEOSTOMY?
So your critically ill loved one has been admitted to Intensive Care and they require invasive or tube ventilation with a breathing tube/endotracheal tube in their mouth and they are attached to a ventilator and they are in an induced coma, in order to be able to tolerate mechanical ventilation as it is quite uncomfortable and painful.
Related article/video:
After a few days of ventilation if your loved one is still unable to “wake up” from the induced coma or if they are unable to “wake up” from a natural coma, therefore your critically ill loved one may still require the breathing tube/endotracheal tube for mechanical ventilation because they can’t manage and protect their own airway through coughing or swallowing and they are also most likely still unable to breathe spontaneously.
Furthermore, the mechanical ventilation and breathing tube/endotracheal tube may also be required to manage a significant respiratory issue such as Pneumonia, ARDS/lung failure, COPD or Asthma just to name a few.
If that is the case, the breathing tube/endotracheal tube and mechanical ventilation is a significant risk and safety issue that continues to require sedation and an induced coma most of the time.
You may have heard the doctors and the nurses talk about performing a Tracheostomy for your loved one, as your loved one is expected to require ventilation for a few more days or even weeks.
As a rule of thumb, it is usually advisable to perform a Tracheostomy after about 7-14 days of ventilation, if ongoing ventilation is expected and if a slow and difficult weaning off the ventilator is expected.
There are other, less common reasons as well that may lead to Tracheostomy, such as swallowing difficulties and/or difficult anatomy such as a short neck that may lead to a Tracheostomy.
Swallowing issues are often an issue after neurological conditions such as stroke, hypoxic brain injury, Traumatic brain injury or seizures.
But before you even want to look at tracheostomy as an option, have a look here to make sure the ICU is doing everything within their power to wean you off the ventilator
The main advantages of a Tracheostomy generally are
• Less sedation is required for your critically ill loved one to tolerate mechanical ventilation- as you may have seen, your loved one may require a fair amount of sedation and opiates(=pain killers) to keep them in an induced coma for ventilation and therefore keep them comfortable. Having a breathing tube/endotracheal tube in the mouth is very uncomfortable and therefore requires sedation and opiates in order to tolerate mechanical ventilation and the breathing tube/endotracheal tube.
With a Tracheostomy, sedation can literally be weaned off immediately after the Tracheostomy has been performed and your critically ill loved one should be able to come out of the induced coma relatively quickly.
Sometimes there are reasons, why your critically ill loved one may still require to stay in an induced coma, even after a Tracheostomy has been performed, however this would only be the case if your loved one remains very unstable for reasons such as raised intracranial(brain) pressures or haemodynamic instability such as low blood pressure and/or irregular heart rhythms or sometimes when on ECMO (ECMO can sometimes be performed on awake Patients)
• Weaning off the ventilator may be commenced the next day after the Tracheostomy has been performed, if your loved one’s condition allows. It may still be a relatively slow process, however your critically ill loved one should be able to spend the first hour or so off the ventilator, once the sedation has been taken away and an assessment can be made on how long it might take to wean your loved one off the ventilator
• Tolerating ventilation with a Tracheostomy is so much easier and doesn’t require a great deal of sedation so that your loved one should be able to at least try and mouth words and is able to move their lips. Also brushing teeth and performing mouth care is so much easier and it only improves the well being for your loved one. A tracheostomy usually doesn’t cause any pain, unlike the breathing tube/endotracheal tube
Related article/video:
• Setbacks can be managed much easier with a Tracheostomy, I.e. if your critically ill loved one needs to go back on a ventilator after time off the ventilator has been achieved, it is easy to switch back and forth between spontaneous ventilation and mechanical ventilation. Often during the day time Patients are able to breathe without the ventilator but during night time mechanical ventilation is required for rest periods
• Mobilisation in a chair is usually a lot easier as well when having a Tracheostomy
• Your loved one may also be able to tolerate sips of water, tea or at least crushed ice and that improves your loved one’s comfort levels as well
There may be times when even a Tracheostomy does not improve your loved one’s condition in the short term and your loved one may have a hard, difficult and prolonged time in Intensive Care, because they are unable to be weaned off the ventilator.
Recommended resources:
Sometimes, despite Tracheostomy ventilation, your critically ill loved one may be kept in Intensive Care for long-term ventilator dependency and that can be a frustrating experience for both, your critically ill loved one and for the families.
If this is the case, you, your Family and your critically ill loved one need to patient to a point and you also need to start thinking about genuine alternatives, if your critically ill loved one stays in Intensive Care for too long. Again, as a rule of thumb, everything above 4 weeks ventilator dependent is far too long and generally requires an alternative approach.
In many countries such as Australia, Germany and the USA many long-term ventilated Adults& Children with Tracheostomy are going home with the help of specialized and dedicated Intensive Home Care services. Check out http://intensivecareathome.com for more information. This service provide a genuine alternative to a long-term stay in Intensive Care.
A pitfall for tracheostomy- especially for our readers in the USA- is simply that after a tracheostomy has been done, Patients are often being “pushed” out of Intensive Care into LTAC or long-term acute care, which is a disaster.
Furthermore, especially when it comes to tracheostomy in the USA, the risk is that once a tracheostomy is performed that the ICU wants to send your loved one to Long-term acute care(=LTAC). This strikes a disaster, as LTAC’s are designed to save money but not to provide quality care for critically ill Patients.
If LTAC is mentioned as an option for your loved one after or before they have a tracheostomy, your alarm bells need to go off and you will need to avoid LTAC at any cost.
I can’t tell you how many desperate families we have calling every week who want us to help them to get their loved ones out of LTAC. We can help them achieve that with our 1:1 consulting and advocacy service, however more importantly we can help you advocate and make a clinical argument to keep your critically ill loved one in the right environment in the first place, which is Intensive Care!
The only place where a Patient can be safely looked after on a ventilator with tracheostomy or with a breathing tube/endotracheal tube is Intensive Care! If you are not clear on this, it could literally cost the life of your loved one!
The only alternative for Patients on ventilation with tracheostomy is INTENSIVE CARE AT HOME where highly skilled ICU nurses provide care in your home for your loved one as a genuine alternative to a stay in Intensive Care.
Why?
I’m glad you’ve asked!
Because anybody on a ventilator needs the skills and expertise of a critical care nurse, critical care doctor etc… Anything less than that is literally killing Patients!
Let me say this again, one more time, because if you’re not clear on what is clinically required for your loved one on a ventilator with tracheostomy could literally kill your critically ill loved one, because LTAC’s simply don’t have the skills, expertise and professionalism to look after a critically ill Patient on a ventilator with tracheostomy!
Most of the time LTAC’s work with doctors and nurses who have no ICU skills and expertise, hence they have no skills and expertise to look after ventilated Patients.
The only place where a Patient can be safely looked after on a ventilator with tracheostomy or with a breathing tube/endotracheal tube is Intensive Care or INTENSIVE CARE AT HOME!
How can you become the best advocate for your critically ill loved one, make informed decisions, get PEACE OF MIND, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?
You get to that all important feeling of making informed decisions, get PEACE OF MIND, CONTROL, POWER AND INFLUENCE when you download your FREE “INSTANT IMPACT” report NOW by entering your email below!
In Your FREE “INSTANT IMPACT” report you’ll learn quickly how to make informed decisions, get PEACE OF MIND, real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Your FREE “INSTANT IMPACT” Report gives you in-depth insight that you must know whilst your loved one is critically ill or is even dying in Intensive Care! Sign up and download your FREE “INSTANT IMPACT” REPORT now by entering your email below!
In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care!
In your FREE report you’ll also discover
- How to ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
- How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
- 5 mind blowing tips& strategies helping you to get on the right path to making informed decisions, get PEACE OF MIND, control, power and influence in your situation
- You’ll get real world examples that you can easily adapt to your and your critically ill loved one’s situation
- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
- You’ll get crucial ‘BEHIND THE SCENES’ insight so that you know and understand what is really happening in Intensive Care
- How you need to manage doctors and nurses in Intensive Care(it’s not what you think)
Thank you for tuning into this week’s “your questions answered” episode and I’ll see you again in another update next week! Make sure you also check out our “blog” section with more tips and strategies or send me an email to [email protected] with your questions.
Also, have a look at our membership site INTENSIVECARESUPPORT.ORG for families of critically ill Patients in Intensive Care here.
You can also call me, find international phone numbers on our contact us page or on the top of the website.
Also check out our Products section where you get more Ebooks, Videos and Audio recordings and where you can also get 1:1 consulting with myself via Skype or over the phone or via email!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
Sincerely,
your Friend
Patrik Hutzel