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 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 that our readers ask quite frequently and the question this week is
“WHAT ARE THE RISKS AND BENEFITS OF A TRACHEOSTOMY?”
If your loved one is critically ill in Intensive Care and if your loved one has been ventilated via an endotracheal tube or a standard breathing tube and if your loved one also hasn’t been able to get off the ventilator and if they haven’t been able to be weaned off the ventilator, the Intensive Care team may have mentioned that they are thinking about performing a tracheostomy.
A tracheostomy tube is a tube that is inserted in a Patient’s neck into the windpipe or trachea. It’s a substitute for the breathing tube or endotracheal tube, if a critically ill Patient can’t be weaned off a ventilator!
There are numerous reasons why a critically ill Patient can’t be weaned off a ventilator and may need a tracheostomy and we have addressed most of the issues in related articles that you can check out here by clicking on the links.
In today’s blog post we only want to focus on the risks and the benefits of a tracheostomy, so let’s dive right into it.
Let’s look at the benefits first.
- A tracheostomy tube is generally speaking a lot easier to tolerate for a critically ill Patient, as opposed to a breathing tube or an endotracheal tube through the mouth. In essence a tracheostomy tube is a breathing tube as well, however it’s in a different location that is much easier to tolerate for a critically ill Patient
- As soon as a tracheostomy has been performed, sedation and opiates(pain medication) can be reduced or even taken away to a bare minimum and a critically ill Patient can either be woken up or it can be attempted to wake a critically ill Patient if they are otherwise medically stable. In any case, by now you would have seen that a breathing tube or an endotracheal tube through the mouth is very uncomfortable and requires a fair amount of sedation to keep your critically ill loved one comfortable
- As soon as the tracheostomy has been performed, the weaning process off a ventilator can be commenced if the clinical condition allows. That means that as soon as sedation is either reduced or taken away and a critically ill Patient is more awake, trials to take away the ventilator for periods of time can be commenced. This would be very difficult without the tracheostomy because critically ill Patients with a breathing tube or endotracheal tube require sedatives and opiates that keep them in an induced coma. The tracheostomy tube tends to be a good conduit to get Patients off sedatives, off opiates(pain medication) and get them out of the induced coma quicker and then start the weaning process off the ventilator!
- The management of suctioning and the management of secretions tends to easier as well, due to the tracheostomy having a short length, compared to a breathing tube/ endotracheal tube. The breathing tube/endotracheal tube is much longer and therefore suctioning and secretion management tends to be far more difficult and also tends to be more uncomfortable. It’s also easier for a critically ill Patient to cough up their own secretions due to having less sedatives in their body system and also due to the tracheostomy tube being shorter compared to a breathing tube/ endotracheal tube!
- Once a critically ill Patient is more stable on the tracheostomy and has had time off the ventilator as well, the next steps can be to use a speaking valve so that they can start talking again. Overall, communication with a tracheostomy tends to be much improved compared to Patients with an endotracheal tube/ breathing tube. This is because of less sedation and also because the mouth is not being obstructed any longer. Even if Patients can’t talk as yet with a speaking valve, they can now use a letter board or can write if they are stable and are not confused or in a coma that’s not related to sedatives and opiates(pain medication)
- If all goes well and your critically ill loved one can be off the ventilator completely, it also should allow for a discharge to a ward area even with a tracheostomy
- Even if you or your critically ill loved one can’t be weaned off mechanical ventilation and the tracheostomy, you can still leave Intensive Care alive and go home with a service like INTENSIVE CARE AT HOME. INTENSIVE CARE AT HOME provides a genuine alternative to a long-term stay in Intensive Care for Patients on ventilation/tracheostomy and/or life support dependency
- A tracheostomy is also a life saving device that enables Patients in Intensive Care to get valuable and precious time to stabilise in their own time when dependent on mechanical ventilation. In essence a tracheostomy is a life saving device that “buys” critically ill Patients in Intensive Care time. Patients can recover in their own time without timelines or quite literally “deadlines” imposed by Intensive Care teams. If Patients can’t recover despite a tracheostomy, there is still plenty of time to discuss end of life care. Not providing a safe and stable airway from my experience such as a tracheostomy when Patients are ventilation dependent and face a long and potentially uncertain recovery in Intensive Care is from my clinical practice and experience not in the Patient’s “best interest”.
- A tracheostomy also allows for improved mouth and oral hygiene. Teeth can be brushed and even though oral food or fluid intake is often restricted with a tracheostomy, small steps towards eating and drinking can be taken by using crushed ice or sips of water. And even though food intake is generally speaking not allowed with a tracheostomy, again small portions of food can be used and lead to more oral food intake even with a tracheostomy
Let’s now look at the risks of a tracheostomy
The major risks of a tracheostomy are that it’s
- An invasive procedure and it requires a cut in the skin
- A foreign body in a critically ill Patient’s windpipe/ trachea
- A tracheostomy needs specialised staff(doctors and nurses) to look after
- Increased infection risk due to the invasive procedure and also due to the bypass of the normal infection prevention structures such as nose and mouth
- A tracheostomy may weaken the trachea or windpipe
- A tracheostomy may block easily and therefore needs constant monitoring
- A tracheostomy is a barrier to communication compared to living without one. It’s improving communication when comparing with a breathing tube/ endotracheal tube
- A tracheostomy may lead to more ventilation support if the weaning off the ventilator fails. Keep in mind that the initial tracheostomy is often done to speed up the weaning process. Therefore, if weaning fails, critically ill Patients can often enter a vicious cycle where they get depressed. Depression, lack of quality of life in combination with ventilator dependency and a long-term stay in Intensive Care can sometimes aggravate the situation and the depression triggers the ventilator dependency and the ventilator dependency triggers the depression.
- 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!
- THE 7 ANSWERS TO THE 7 MOST FREQUENTLY ASKED QUESTIONS IF YOUR LOVED ONE REQUIRES ONGOING MECHANICAL VENTILATION WITH TRACHEOSTOMY IN INTENSIVE CARE!
I hope that helps and I hope that clarifies how you can weigh up risks and benefits if your critically ill loved one may need a tracheostomy.
Please let me know if you have any questions. Send your questions to [email protected]
How can you have PEACE OF MIND, control, power and influence whilst your loved one is critically ill in Intensive Care?
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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
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- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
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- 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” 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!