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

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 that our readers ask quite frequently and the question last week was

“How long can a critically ill Patient stay on ECMO?”

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 one of our readers and this week, Chris from Denver asks.

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

Hi Patrik,

My 75 year old father has been on a ventilator with tracheostomy for about four weeks after he developed a severe Pneumonia after he had open heart surgery for a bypass.

Thankfully, after a long and arduous process, he managed to stay off the ventilator, but he still has his Tracheostomy in. He has been off the ventilator for 5 days now and only requires some humidification through the Tracheostomy.

He is coughing up a fair amount of sputum and he does require regular suctioning from the nurses.

As you can imagine, we as a family and my father as well are quite keen to have the Tracheostomy removed as quickly as possible as well.

The doctors are saying that as long as he still has many secretions coming up that they don’t want to remove the Tracheostomy as yet.

My father is desperate to talk and he’s desperate to eat and drink.

We are worried that this is dragging on for much longer than necessary and we want to find out what the options are and how long after somebody has been weaned off the ventilator the Tracheostomy can be removed?

Your advice is much appreciated.

Chris

Hi Chris,

thank you for making contact and thank you for sending your question through!

It sounds like your father and your family have been through a lot, as generally speaking open heart surgery in most cases tends to be fairly straight forward these days, as long as it’s elective or planned.

That didn’t appear to be the case with your father and I’m very sorry to hear that he ended up in Intensive Care for more than four weeks on a ventilator and the Tracheostomy.

Recommended resources:

THE 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 REQUIRES LONG-TERM VENTILATION WITH TRACHEOSTOMY IN INTENSIVE CARE!

Thankfully, he managed to stay off the ventilator and the next natural step is to obviously have the Tracheostomy removed as well.

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

Your father 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 father 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

After your Dad 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 requirement before the tube can be removed.

So please Chris, if you are unsure you now have the guidelines for Tracheostomy removal to give back to the Intensive Care team and you can prompt them towards the steps of those guidelines.

What you can also do in the meantime is to ask the Physiotherapy to do more breathing and coughing exercises with your Dad, as often the respiratory or breathing muscles get tired and exhausted after prolonged mechanical ventilation.

Therefore, your father might have to build up some of that strength first before they can remove the Tracheostomy.

I hope that helps Chris.

Please let me know if you have any other questions.

Sincerely,

your friend

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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5 “killer” tips& strategies helping you to get on the right path to PEACE OF MIND, control, power and influence in your situation
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!