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
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
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.
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.
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
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
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.
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.
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
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!
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!
Or you can call us! Find phone numbers on our contact tab.
Also check out our Ebook section where you get more Ebooks, Videos and Audio recordings and where you can also get 1:1 counselling/consulting with me via Skype, over the phone or via email by clicking on the products tab!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
- The 10 COMMANDMENTS for PEACE OF MIND, control, power and influence if your loved one is critically ill in Intensive Care
- What could be the cause if my critically ill loved one is removed from an induced coma but still hasn’t woken up?
- My 80 year old father is in Intensive Care with Myeloma! The Intensive Care team HAS ASKED ME TO SIGN A “DNR” AND I REFUSED! What are MY OPTIONS?
- The 3 most dangerous mistakes that you are making but you are unaware of, if your loved one is a critically ill Patient in Intensive Care
- The 5 questions you need to ask when the Intensive Care team is talking about “Futility of treatment”, “Withdrawal of life support” or about “Withdrawal of treatment”
- HOW TO STOP BEING HELD HOSTAGE BY THE INTENSIVE CARE TEAM if your loved one is critically ill in Intensive Care!
- 5 POWERFUL THINGS YOU NEED TO DO IF THE INTENSIVE CARE TEAM IS NEGATIVE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- My Mum has been diagnosed with STOMACH CANCER and is in ICU ventilated. CAN I TAKE HER HOME on a ventilator?
- The questions you need to ask the most senior doctor in Intensive Care, if your loved one is critically ill in Intensive Care
- How long does it take for my critically ill loved one to be taken off the ventilator and have their breathing tube/ endotracheal tube removed
- Why you must make up your own mind about your critically ill loved one’s situation in Intensive Care even if you’re not a doctor or a nurse!
- The ELEPHANT IN THE ROOM or HOW THE INTENSIVE CARE TEAM IS MAKING DECISIONS whilst your loved one is critically ill in Intensive Care!
- MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO?
- 5 ways you are UNCONSCIOUSLY SABOTAGING yourself whilst your loved one is CRITICALLY ILL in Intensive Care and HOW TO STOP doing it!
- How to make sure that “what you see is always what you get” whilst your loved one is critically ill in Intensive Care
- 5 Ways to have control, power and influence while your loved one is critically ill in Intensive Care
- Family overjoyed as top court rules doctors must seek consent before taking a patient off life support
- How to make sure that your values and beliefs are known whilst your loved one is critically ill in Intensive Care
- My loved one has HIV, lymphoma on his brain, seizures, septic and is ventilated! The Intensive Care team is trying to TAKE MY HOPE AWAY and they are all NEGATIVE! HELP!
- MY PARTNER IS IN INTENSIVE CARE AFTER A BLEED ON A BRAIN! WE ARE WORRIED THAT THE INTENSIVE CARE TEAM WANTS TO SWITCH OFF THE VENTILATOR! HELP!
- HOW TO DEAL WITH A DIFFICULT INTENSIVE CARE TEAM, WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- What the doctors and the nurses behaviour in Intensive Care is telling you about the culture in a unit
- How to take control if your loved one has a severe brain injury and is critically ill in Intensive Care
- How can I be prepared, be mentally strong and be well positioned for a Family meeting with the Intensive Care team?(PART 1)
- How can I be prepared, be mentally strong and be well positioned for a Family meeting with the Intensive Care team?(PART 2)
- The four DEADLY SINS that Families of critically ill Patients in Intensive Care CONSTANTLY MAKE, but they are UNAWARE OF!
- My HUSBAND had a HORRIBLE work accident and went into CARDIAC ARREST! Will he be PERMANENTLY DISABLED
- Why decision making in Intensive Care GOES WAY BEYOND your critically ill loved one’s DIAGNOSIS AND PROGNOSIS!
- The 4 ways you can overcome INSURMOUNTABLE OBSTACLES whilst your loved one is critically ill in Intensive Care!
- How to get PEACE OF MIND, more control, more power and influence if your critically ill loved one is DYING in Intensive Care!
- The 5 QUESTIONS you need to ask, if the Intensive Care team wants you to DONATE your loved one’s ORGANS in an END OF LIFE SITUATION!
- MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO? (PART 1)
- How MEDICAL RESEARCH DOMINATES your critically ill loved one’s diagnosis and prognosis, as well as the CARE and TREATMENT your loved one IS RECEIVING or NOT RECEIVING
- WHAT WOULD YOU DO if you knew that you COULD NOT FAIL, whilst your loved one is critically ill in Intensive Care
- How the Intensive Care team is SKILFULLY PLAYING WITH YOUR EMOTIONS, if your loved one is critically ill in Intensive Care!
- My father is in Intensive Care ventilated with LIVER FAILURE and KIDNEY FAILURE, I DON’T THINK HE WILL SURVIVE! HELP
- HOW TO GIVE YOURSELF PERMISSION TO HAVE PEACE OF MIND, CONTROL, POWER AND INFLUENCE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- My father has been weaned off the ventilator in Intensive Care and still has the Tracheostomy in. When can the Tracheostomy be removed?