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Can My Dad have the Tracheostomy Removed at Home? Quick Tip for Families in Intensive Care!

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

So, today’s tip is again questions asked from one of our members in our membership for families of critically ill patients so that you can actually see what you get if you want to become a member in our membership as well.

So, let’s read out the question from our member, “Hi, Patrik and team. The ejection fraction is in the low 40s so they explained that’s considered mild and could have been onset from all the bouts of sepsis. Below 35% is severe, they explained. My dad’s been accused of having chronic osteomyelitis many times, often times it’s not the case and that’s why we are questioning the accuracy of this diagnosis. The wounds are healthy looking and don’t smell but get deep quickly and take a long time to heal. You can’t see the bone in any of the wounds.

We will ask for a nephrology consult to see if they can weigh in on exactly how much fluid dad should be getting. We already told the hospitalist that we don’t want to leave without an exact plan as to how much fluids he should be getting.

Regarding being a long-term patient, he hasn’t been home for more than two weeks cumulatively since October. He was at the other LTAC for two months. He can’t go home until he is decannulated, decannulation means removal of a tracheostomy, because he will never be decannulated at home. That has been explained to us several times. We don’t really have a choice but to go to another LTAC since dad’s goal is to be decannulated.

I’ll ask for a nephrology consult as per your recommendations but don’t really have any other questions to ask the doctors besides:

Number 1, what kind of medications would be prescribed for heart failure? There are none on his medication list currently.

Number 2, the doctor said a few days ago that a long-term antibiotic wasn’t the answer since he has been on them so long already. Are we going back to that because the wrong antibiotics were given in the past or weren’t given consistently (stopped and started over and over)?

 When we go to an LTAC (long-term acute care), we’ll make sure dad is being mobilized, efforts are being made to continue decreasing secretions and he is on the path to decannulation.”

Here’s my response, “Thank you for your email. I hope the following will answer your questions.

“Number 1, what kind of medications will be prescribed for heart failure? There are none on his medication list currently.” Some medications for mild heart failure with low ejection fraction are the following. These medicines can be given in combination or not depending on your dad’s comorbidities or premedical history. (A), Diuretics, as needed, also known as water pills, helps to pass more urine, eliminate excess fluid from the body, and decongest the lungs. Examples are furosemide (Lasix), Bumetanide, Spironolactone. (B), SGLT2 inhibitors reduce worsening of heart failure. Example, dapagliflozin and empaglifolozin. (C), ACE inhibitors help widen or dilate blood vessels to improve blood flow to the heart. Examples are Enalpril, Captopril, Lisinopril, with suffix ‘-pril’. (D), Angiotensin II receptor blockers helps relax and widen blood vessels and reduce salt and water retention. This medication is prescribed for those who cannot tolerate ACE inhibitors. Examples are Losartan, Valsartan, Candesartan, once again with suffix ‘-sartan’. (E), Mineralocorticoids receptor antagonist helps the kidney remove more fluids from the body while ensuring that potassium won’t drop low. Examples are Spironolactone or Aldactone, which I mentioned before is a potassium saving diuretic. (F), Beta blockers provide heart rate control and reduce the force at which rate blood is pumped around the body. This can cause a decrease in heart rate. Examples are metoprolol, bisoprolol, carvedilol, again ending with the suffix ‘-lol’.

Next, “The doctor said a few days ago that long term antibiotics wasn’t the answer since he has been on them so long already. Are we going back to that because the wrong antibiotics were given in the past or weren’t given consistently (stopped and started over and over)?” To determine the correct antibiotics to give, a wound culture is needed first, ideally, to identify what bacteria grew on the site like in the pressure sore.

A swab is taken from the pressure wound and will be checked in the laboratory. If there is no significant growth in the wound culture, antibiotics are not needed. If there is, an antibiotic specifically to kill the bacterial (either gram positive or gram negative) should be given. Maybe the reason why the doctors are avoiding antibiotics for now, since he has been on antibiotics for some time, is that he might develop multidrug resistance caused by wrong or misused antibiotics. This is also not good. I recommend asking your infectious disease doctor to explain to you about the antibiotics use. If there is fever and the white blood counts are still high, it means there is still active infection.

I hope they can address the leukocytosis and stabilize the vital signs.”

Also, you mentioned you want to get a nephology consult. Absolutely. You should be getting a nephrology consult before he’s going to LTAC.

Another thing that I have said in one of my other emails to you is I would recommend you not going to LTAC, whatsoever. You are talking about they want to mobilize him, and they will mobilize him. I only believe it when I see it in an LTAC. Most LTACs do not mobilize patients. LTACs are designed to save money. They are not designed to provide best clinical care.

Now, what I would do is I would ask them to start mobilizing your dad right here and then. There’s nothing stopping them from besides potentially being lazy, complacent, whichever adjective you want to use. Do not stop asking. Keep asking.

Then you are talking about, “He can’t be decannulated, until he’s in LTAC.” That’s nonsense. He can be decannulated now if they’re doing the right things. You also mentioned, “He can’t be decannulated at home”, again, that is not accurate.

So, when you look at our intensivecareathome.com website and our service there, we are providing Intensive Care at Home for our clients all around Australia. With Intensive Care at Home, we have decannulated clients at home. So, just don’t be blindsided by outdated hospital paradigms and saying this is not possible and that it is not possible. You have to look what’s out there.

Now, while I can’t help you in the United States at the moment, for anyone watching this who’s in Australia, for example, if you are in a similar situation, with our Intensive Care at Home service, we can decannulate tracheostomy clients at home and we have done so successfully. So, go to intensivecareathome.com and find more information there. But the notion that your dad can’t be decannulated at home is not accurate.

Also, with your dad potentially or at risk going back to LTAC, I see that as a massive risk. The hospital can’t transfer him to LTAC without your consent. So, don’t let them blindside you and saying, “Well, here’s what’s going to happen, and you have to do whatever we’re going to tell you”, that is not accurate. Put a stop to that and you will see your dad will improve much quicker if he stays in the right environment.

So, that’s the question answered for our member.

If you want to become part of our membership for families or critically ill patients in intensive care, go to intensivecaresupport.org. There, you get 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 one on one consulting and advocacy over the phone, via Skype, via email, via Zoom, whichever medium works best for you. I talk to you and the doctors and the nurses directly. I talk to some of your other family members if you wish. I also can represent you in any phone calls or meetings with the doctors and nurses, and in any family meetings, I can represent you, making sure your loved one gets best care and treatment, making sure you can make informed decisions, get peace of mind, control, power, and influence fast whilst your loved one is critically ill in intensive care.

Also, we offer medical record reviews in real time while your loved one is in intensive care so you can get a second opinion in real time. 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, if you have any questions regarding our services, just go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or simply send us an email to [email protected].

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, comment below what you want to see next or what questions and insights you have, and share the video with your friends and families.

Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.

Take care for now.

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