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
You can read, watch or listen to last week’s episode here.
In this week’s episode of “your questions answered”, I answer a question that many of our readers want to know about if their loved one is critically ill in Intensive Care and in this week I want to answer
“How long can a critically ill Patient be on a ventilator with a Tracheostomy in Intensive Care?”
Any topic that’s related to ventilation and Tracheostomy in Intensive Care seems to bring up a ton of questions, as there is understandably a lot of fear, uncertainty and frustration around the issues that come with ventilation and Tracheostomy in Intensive Care.
Many Families of critically ill Patients in Intensive Care approach INTENSIVECAREHOTLINE.COM in order to have their questions answered around their critically ill loved one’s situation in Intensive Care, as well as it relates to breathing tubes, induced coma and Tracheostomy in Intensive Care! If you have a specific question about your critically ill loved one’s situation in Intensive Care you can send me an email to [email protected] and I’ll answer your question as well!
If you have come to this website to look for advice as it relates to your critically ill loved one’s situation in Intensive Care and their ongoing ventilator dependency and their Tracheostomy in Intensive Care, there’s a few things I want to shed light on in order to answer your question!
The longer your critically ill loved one stays on the ventilator with Tracheostomy, the more difficult it gets
If your critically ill loved one has had a Tracheostomy for ongoing ventilator dependency in Intensive Care and is still not off the ventilator, after many days, weeks or even months, the reality is that the longer it takes for your critically ill loved one to be weaned off the ventilator the harder and the more difficult it generally gets.
The unfortunate reality often is that the ventilator dependency is often a psychological dependency and the reality also is that Intensive Care is not the right environment to wean somebody off the ventilator, but I’ll come to that later and I’ll shed light on the right environment.
As a rule of thumb, you need to know that after a Tracheostomy has been inserted in Intensive Care, most of the time the weaning process should start the next day unless there are any contraindications, such as ongoing haemodynamic, respiratory or neurological instability. Haemodynamic instability may show up as low or high blood pressure and/or irregular heart rhythm, respiratory instability may show up as in having difficulties breathing off the ventilator and a neurological instability may show up in severe and traumatic head injuries or during seizures.
All other things being equal and stabile, there should be no reason why weaning off the ventilator can’t be commenced the very next day after a Tracheostomy has been inserted.
Weaning off the ventilator starts with a couple of hours off ventilation with increasing frequency
Normally, the weaning process should start with taking your critically ill loved one off the ventilator for a couple of hours as a starting point and increase the frequency every day and as tolerated. The goal here is to have your critically ill loved one off the ventilator during the day in a few days and off the ventilator completely within 1-2 weeks. Of course, it all depends and if your critically ill loved one is unstable then this may not be achieved within the mentioned time frame of 1- 2 weeks.
In the ideal world, once your critically ill loved one can breathe without the ventilator and after the Intensive Care team and/or the speech pathologist has established that your critically ill loved one can swallow, breathe and cough then the Tracheostomy can be removed. After your critically ill loved one has come off the ventilator a discharge to the ward may even occur with the Tracheostomy still in place and the Tracheostomy may be removed on the ward.
In case your critically ill loved one is struggling to come off the ventilator with a Tracheostomy and if after many weeks or even many months in Intensive Care, your critically ill loved one is depressed, has no Quality of Life, has no or very little privacy and dignity and is just generally sick of being at the mercy of other people, we need to look at some of the issues closer.
Long-term ventilator dependency and Tracheostomy in Intensive Care comes with its unique challenges and generally speaking, the longer your critically ill loved one is ventilator dependent in such a restrictive, depressing and inhibiting environment such as Intensive Care, the harder and the more difficult and challenging it gets to wean your loved one off the ventilator.
There is no time limit for your loved one to be ventilated with Tracheostomy
To answer the question that we set out to answer initially, a Patient with a Tracheostomy who’s ventilator dependent can stay on a ventilator forever. There is no such thing as a time limit.
However, as I have mentioned before, the longer the ventilator dependency with Tracheostomy in the inhibiting and depressing environment that is Intensive Care, the more difficult it gets to get your critically ill loved one off the ventilator, since there is often a vicious cycle at play with the ventilator dependency triggering depression and the depression triggering the ventilator dependency, especially if your loved one had a few failed attempts to be weaned off the ventilator. On top of that there is often a disturbed day and night rhythm, with a lack of sleep and sleep deprivation in a busy, noisy and unpleasant environment!
Your critically ill loved one generally gets very frustrated, depressed, even angry and the longer the stay in Intensive Care and the longer the dependency on the Intensive Care team, the more frustrating the experience gets for all parties involved, your critically ill loved one, for the Intensive Care team and for you and your family.
Furthermore, the experience of having a loved one critically ill in Intensive Care on a ventilator with Tracheostomy also increases the likelihood of your critically ill loved one to catch an infection, due to the Intensive Care environment with lots of bugs flying around and also because of the depression and frustration.
So what’s the way out of the dilemma?
That’s a great question to ask and generally speaking there are a few things you need to know, understand and things you can implement from your end in order to improve the situation such as
- motivate and inspire your loved one and bring in some Family photos
- Other practical steps would be to look at continuity of care such as
- having regular and experienced nursing staff looking after your critically ill loved one(some units have a tendency to let their junior staff or agency staff look after their long-term Patients, as the more experienced staff tend to look after more acutely unwell Patients)
- making sure your critically ill loved one is getting natural daylight such as having visits outside as soon as their condition allows
- think about whether your loved one can get a quiet room with natural daylight or is your loved one exposed in the middle of a busy unit with no natural daylight?
- make sure that the Intensive Care team are on top of things, again some units have the tendency to almost neglect their long-term Patients, because the staff are getting frustrated as well
- ask the Intensive Care team whether your loved one might be better off with antidepressants in the interim. Antidepressants are not a long term solution though
- make sure that your critically ill loved one gets regular showers and washes and gets out of bed on a regular basis
- no matter how difficult the situation, stay positive, your critically ill loved one will feel the positive vibes coming from your family
- the longer your loved one stays in ICU the higher the risk of your loved one catching an infection, therefore a side room with no exposure to other Patients and therefore bugs might be an advantage as well
The Ebooks and Videos that are highly relevant if your loved one is critically ill on a ventilator are (click on the links)
- “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”
- “Follow this proven 6 step process on how to be in control and influential if your loved one is a long-term Patient in Intensive Care or is facing treatment limitations in Intensive Care”
- “The 5 things you need to know if the medical team in Intensive Care wants to limit treatment, wants to withdraw treatment or wants to issue an NFR(not for resuscitation) order for your critically ill loved one in Intensive Care”
As far as your critically ill loved one’s Tracheostomy goes, again it’s nothing unusual in Intensive Care to see Patients having failed attempts to wean them off the ventilator and the Tracheostomy for the reasons I that mentioned above.
Depending on where you live, you might also consider external specialized services such as INTENSIVE CARE AT HOME. There are services available in countries such as Germany, USA and Australia who focus on weaning long-term ventilated Patients in the home as a genuine alternative to a long-term stay in Intensive Care, generally with a focus on Quality of Life for Patients and their Families. You can find more information at http://intensivecareathome.com.au
That also leads me to where I believe the right place is for any long-term ventilated Patient with Tracheostomy is and that is their own home.
Because I have worked with long-term ventilated Adults& Children with Tracheostomy in their own home as a genuine alternative to a long-term stay in Intensive Care, you wouldn’t believe how much Patients and their Families blossom once they are out of Intensive Care and have gone home with specialized services such as INTENSIVE CARE AT HOME. Those services provide a genuine alternative to a long-term stay in Intensive Care and nothing, but nothing beats home, especially for somebody who has been in Intensive Care for long periods of time.
The harsh reality also often is that Intensive Care Units don’t want you to get too involved in their decision making process. However if you are finding that things are not improving then it’s time that you start questioning the Intensive Care team’s approach and then it’s time that you take charge, take control, have power and influence!
The unfortunate reality is also often that if your critically ill loved one is ventilator dependent with Tracheostomy that the ICU thinks that if your critically ill loved one is not progressing then it might be “in the best interest” of your critically ill loved one to “limit” or “withdraw treatment”.
- The 5 reasons why you need to be difficult and demanding when your loved one is critically ill 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 can you further leverage your level of power, influence and control whilst your loved one is critically ill in Intensive Care?
You’ll get to that all important feeling of power, control 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 get real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Our FREE reports help you with in-depth insight that you must know whilst your loved one is critically ill or is dying in Intensive Care! Sign up for your FREE membership and download your FREE “INSTANT IMPACT” REPORT now!
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 “killer” tips& strategies helping you to get on the right path to 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 episode of “your questions answered” and I’ll see you again in another update next week! Make sure you also check out our “blog” section for more tips and strategies or send me an email to [email protected] with your questions!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!