My 78 year old Mom has lung cancer and developed an infection! She’s in ICU on the breathing tube, can she get off it or will she need a tracheostomy? (PART 4)

Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, 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 in this series of questions from my client Melissa and the question last week was PART 3 of

My 78 year old Mom has lung cancer and developed an infection! She’s in ICU on the breathing tube, can she get off it or will she need a tracheostomy? (PART 3)

You can check out last week’s episode by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next question in this series of questions from one of my clients Melissa, which are excerpts from phone and email counselling and consulting sessions with me and the question this week is

My 78 year old Mom has lung cancer and developed an infection! She’s in ICU on the breathing tube, can she get off it or will she need a tracheostomy? (PART 4)

Previous questions answered from Melissa, you can find here

PART 1, PART 2 and PART 3

Melissa writes

Hi Patrik,

quick update. Mom breathed with less support from 10:30 AM until 2:30 PM. Staff optimistic she will get into long term rehabilitation soon.

Still doing tracheostomy on Monday. She really wants it as she is getting desperate to get her mouth free from tube.

GREAT NEWS. The doctor I emailed you about? He’s gone! Today last day of rotation. Staff told me. I had no clue but apparently he is..to put it delicately not the most popular. Gee..I wonder why.

Thank you for all the help. My dad told me your talk went well. Will keep you updated.

Melissa

Hi Melissa,

good to hear that your mother needs less support for now.

I’m still not convinced that they have maximized chances to get your mother coming off the ventilator without needing a tracheostomy in the first place.

I understand why your mother wants a tracheostomy with being in such a desperate situation.

Your Dad mentioned the long-term rehab facility having a good reputation.

No amount of skill and reputation of the rehabilitation facility can replace getting off the ventilator and the breathing tube in the first place without needing a tracheostomy.

I have seen those situations over and over again.

I know I must sound like a broken record when I say that I believe your mother could have and might still be able to come off the ventilator and the breathing tube when asking the right questions and when following best practice as described here

HOW TO WEAN A CRITICALLY ILL PATIENT IN INTENSIVE CARE OFF THE VENTILATOR AND THE BREATHING TUBE!

You simply don’t know what you don’t know…

Because the ICU is most likely pushed for beds and they want to send your mother out to free up their beds, this may just one of the reasons they want to do a tracheostomy, rather than trying to wean her off the ventilator and breathing tube, whilst continuing to answer all your questions…

Besides, any ICU should be able to wean somebody off the ventilator on a tracheostomy as well.

Again, in order to get the outcomes you want you need to ask the right questions. They also know that you don’t know what questions to ask.

I’m here to help, even if your mother is in a rehabilitation facility. Being on a ventilator is high risk and weaning somebody off the ventilator can be a challenge. Every day can count.

Check out this article/video here for more information

TRACHEOSTOMY AND WEANING OFF THE VENTILATOR IN INTENSIVE CARE, HOW LONG CAN IT TAKE?

We are currently working with another client in California who has their mother in a rehabilitation facility that we help to get their mother off the ventilator.

Why would you send your mother to rehabilitation on a ventilator with tracheostomy if she might be able to have the breathing tube out in the first place?

Your mother might need rehab in the future, but imagine how much more effective rehab would be without a ventilator and tracheostomy!

Also, any ICU should be in a position to wean a Patient off a ventilator and a tracheostomy, no need for lengthy rehabilitation on a ventilator.

An optimum rehabilitation is one where the focus is on physical rehabilitation and not on ventilator weaning. That’s why I’m so adamant that ventilator weaning needs to be done in Intensive Care and then they can shift the focus on physical rehabilitation rather than ventilator weaning!

Looking after somebody on a ventilator is a highly specialized skill and rehab facilities often work with non- ICU trained RN’s that are not ventilator competent.

I assume you don’t know what you don’t know and that’s fine.

After nearly 20 years working in Intensive Care I think I have a fairly good idea what’s possible, what’s not possible and I also have a good understanding where ICU’s compromise Patient care for the sake of the Dollar $$$ or for the sake of their bed management goals.

Generally speaking rehabilitation facilities(long-term acute care is implying LONG-TERM and not short-term) are not known for weaning somebody off the ventilator quickly.

Imagine how much easier physical rehabilitation would be if your mother is off the ventilator!

I leave this to you and your Dad, you know where I am.

Kind Regards

Patrik

Recommended:

1:1 email counselling and consulting with Patrik

1:1 phone and email counselling and consulting with Patrik

Hi Patrik,

thank you for your thoughts,

No Tracheostomy today. Maybe Wednesday. A lot depends on the weather, because of the snow storm coming because we want to be there…

I get what you mean but it is going on 3 weeks now. We have the answers to all the questions you told us to ask and now they are moving her, giving her breathing tests etc.

I was there today when they tried. For some reason she cannot breathe on her own. You told me if we asked all the questions and they were doing everything then a tracheostomy would seem an option.

We got a second opinion from another doctor and my dad has a respiratory doctor he knows who also gave him the opinion that a tracheostomy is needed.

I would LOVE if she could be off the breathing tube…I do know that some places may not be well equipped which is why we are doing so much research.

But the bottom line is she wants it, the hospital wants to do it, three doctors have told us she needs it and we have also been told it is or could be reversible and that it maybe easier for her to breath on her own eventually with the tracheostomy and then without it.

That about covers it. We are /doing all we can and everybody has been great including you. We will continue to do whatever we can to get her better.

Melissa

Hi Melissa,

Thanks for the update.

I appreciate that they have tried and that she simply can’t breathe by herself yet.

It’s been three weeks now and as I explained before in some articles and videos, three weeks is about as long as someone can tolerate a breathing tube, I generally speaking agree that it’s too long now and they will need to proceed with the tracheostomy!

Just as a quick reminder, here are the articles and videos again for when to do a tracheostomy

HOW LONG SHOULD A PATIENT BE ON A VENTILATOR BEFORE HAVING A TRACHEOSTOMY?

How Long Can A Breathing Tube Or An Endotracheal Tube Can Stay In?

Why Would A Critically Ill Patient In An Induced Coma Need A Tracheostomy In Intensive Care?

WHAT ARE THE RISKS AND BENEFITS OF A TRACHEOSTOMY?

Moving forward, once your Mom has the tracheostomy and she’s medically stable, they will probably proceed moving her to LTAC(=long-term acute care facility) rather sooner than later.

For Intensive Care Units LTAC is often one avenue to empty their precious, expensive and “in-demand” ICU beds.

You’ll probably be surprised in the difference you will notice going from ICU to LTAC.

Your mother will be leaving an environment of highly skilled staff and she’ll be going to an environment with far less skilled staff, even though she will require highly specialized skills because she’s ventilated with a tracheostomy.

You also have to keep in mind that if there are complications like an infection, a change in hemodynamic status such as a low blood pressure and the requirement for inotropes/vasopressors she will need to come back to Intensive Care.

You can probably hear that I’m not advocating for LTAC’s at all and I have many reasons why not, because we’re dealing with far too many enquiries about LTAC where families are telling us that if they had known how poorly LTAC’s are run they would have kept their loved ones in Intensive Care…

Again, you don’t know what you don’t know…

I really hope your mother will go into a good LTAC, but I don’t think there are many good ones out there.

Once she’s in LTAC(=long-term acute care), make sure she’ll get physical therapy, gets out of bed regularly, has time off the ventilator, she gets good nursing care including regular showers- and yes, she can have a shower even while she’s ventilated, don’t let them tell you anything else- and hopefully they can wean her off the ventilator.

You see, LTAC’s are meant to be an extension of Intensive Care, but they are not. They don’t work with ICU nursing staff and they often only have one doctor on site for dozens of Patients.

It’s certainly not the kind of care I would want for myself or for my loved ones.

Going from Intensive Care to LTAC is a huge drop in care and skills provided, don’t say I haven’t warned you.

I really hope that things are going well going forward from here and hopefully your mother can be weaned off the ventilator and then the tracheostomy as next steps.

I’m looking forward to talk to you soon!

Warm Regards

Patrik

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