My husband is quadriplegic and has been off the ventilator for more than two weeks! The Intensive Care team wants to send him home with a Tracheostomy but I don’t believe he’ll need the Tracheostomy! Help!

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 have 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 one of our readers and the question last week was

“My friend is in ICU ventilated with Leukaemia! The doctors have made her “DNR”! I disagree, what are the best options?”

You can check out the answer to last week’s question by clicking on the link here.

In this week’s episode of your questions answered I want to answer another question from our readers and in this week Judy, from Vancouver, Canada asks

“My husband is quadriplegic and has been off the ventilator for more than two weeks! The Intensive Care team wants to send him home with a tracheostomy but I don’t believe he’ll need the tracheostomy! Help!”

Judy writes

Hi Patrik,

My husband is a quadriplegic and had a serious Pneumonia!

He was vented for 2 weeks had a Tracheostomy done for pulmonary toileting for very thick secretions.

It is now 2 weeks since the Tracheostomy and my husband’s lungs are clearing nicely!

There are very little secretions left and his O2(Oxygen) saturations are ranging around 97%.

He has passy Muir speaking valve and he is taking foods well. They want to send him home leaving the Tracheostomy. He was perfectly fine before the Pneumonia. Is it necessary for a permanent Tracheostomy?

My husbands injury was C6/C7 incomplete and was 11 years ago. He has been off the ventilator for over 2 weeks is speaking fine with the passy Muir speaking valve and has only been suctioned twice in 24 hours. His last chest X-ray was clear. Yesterday the Respiratory Therapist said there was good air entry throughout the lungs and his chest sounded clear.

The reasoning I have been given for a permanent Tracheostomy is that if he gets Pneumonia again I will have clear access to suction. I am a retired RN director of nursing so I have insight into this. I have asked to have my husband seen by a respiratory physician for further explanation.

Thx so much for your response

Judy

Dear Judy,

thank you for making contact.

I am very sorry to hear that your husband was perfectly fine without the Tracheostomy prior to his hospital admission for Pneumonia.

From what you are describing, especially if he is taking foods well, my first guess would be that the Tracheostomy doesn’t have to stay.

However, two weeks with a Tracheostomy and without trying to take it out is by far too early to suggest that the Tracheostomy has to stay in.

But this is just my first guess without actually knowing for sure, however if your husband was fine without a Tracheostomy before the Pneumonia there shouldn’t be any reason why he should need it now.

Is your husband still requiring ventilation support? How often does he need suctioning? Can he talk with the passy muir valve?

From what you are describing, there should be no reason why the Intensive Care team shouldn’t be able to take out the Tracheostomy tube.

Recommended resources:

“7 answers to the 7 most frequently asked questions, if your loved one requires ongoing mechanical ventilation with Tracheostomy in INTENSIVE CARE”

“Follow this proven system to avoid the 3 most dangerous mistakes you are making but you are unaware of, if your loved one is a long-term ventilated Patient with Tracheostomy in Intensive Care”

The reasoning that if your husband “will get Pneumonia again” is just not a strong and convincing reason to live with a Tracheostomy permanently.

Of course you should be taking their opinion into consideration, however a “what if” scenario should not be the reason for somebody to permanently live with a Tracheostomy.

It also means that if your husband is requiring suction twice daily and if he is able to cough then they should at least try and take it out.

Why don’t they try anyway while he is still in hospital?

You should also look into the guidelines for Tracheostomy removal here

As a rule of thumb, the current guidelines for Tracheostomy removal should be considered before removing the Tracheostomy (decannulation)

Your husband should be off the ventilator for at least 3-4 days, which it sounds like he has been

He should be able to cough and swallow and therefore not at any risk of aspiration(aspiration is the entry of stomach content or sputum into the lungs after swallowing or vomiting)

The frequency of suctioning, therefore suctioning should be at a minimum and less than once or twice a day

Your husband should be able to clear and maintain his own airway and he should therefore be able to cough up his secretions

Generally speaking the Tracheostomy protects from aspiration because of the blocking of the trachea(wind pipe) with a cuff

A normal and satisfactory ABG(Arterial blood gas) test, which checks the level of oxygen(O2) and carbon dioxide(CO2) in the blood
Oxygen saturation in the blood above 93-94%

A normal and clear chest x-ray that doesn’t suggest anything malicious like an infection, collapse or Pneumonia

A swallowing test that is normal, because again after Tracheostomy removal you want to make sure that there is no aspiration and that your father can actually enjoy some food and drinks. A swallowing test should be carried out by the speech pathology team

You can also check out the answer to a similar question from a reader here

My father has been weaned off the ventilator in Intensive Care and still has the Tracheostomy in. When can the Tracheostomy be removed?

After your husband fulfils all of those requests, his tracheostomy may be plugged(closed) for twenty four hours and they are monitored for breathing/respiratory difficulty or suction requirements before the tube can be removed.

In any case you should be fighting for what you believe is the right thing to do!

I believe it’s very poor from the Intensive Care team to not try harder and improve your and your husband’s quality of life.

A Tracheostomy is a big impairment and he should have it removed if possible!

It sounds to me like you have insight anyway, however you should not be giving in to the Intensive Care team’s demands and plans!

Please let me know if there is anything else I can help you with!

Thank you& Kind Regards

Patrik Hutzel

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Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
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How to stop being intimidated by the Intensive Care team and how you will be seen as equals
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How you need to manage doctors and nurses in Intensive Care(it’s not what you think)

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