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5 Things ICU’s Won’t Tell You About Tracheostomies! Quick Tip for Families in Intensive Care!

Five things ICUs won’t tell you about tracheostomies. That’s what I’m going to talk about today.

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

Here at intensivecarehotline.com, we instantly improve the lives of families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power and influence, even if you’re not a doctor or a nurse in intensive care.

Again, today, we talk about the five things that ICUs won’t tell you about tracheostomies. Let me be broadly honest with you here. ICU teams often push families into making rush decisions about tracheostomies without giving them the full picture. If you’re not asking the right questions, you’ll be left making critical life or death decisions in the dark.

So, what is it they’re not telling you?

Number 1. Tracheostomy is not the end; it’s a new beginning. When your loved one can’t be weaned off the ventilator and the breathing tube, the ICU will often recommend a tracheostomy after 10 to 14 days of mechanical ventilation with a breathing tube. They often say that it’s the next step or that it’ll make things easier.

But here is what they don’t say, the tracheostomy can often buy time, but it also prolongs the ICU journey, potentially shifting your loved one to long term care or LTAC (long-term acute care) if you’re in the United States, which often provides substandard care compared to ICU.

Another option can be to go home with Intensive Care at Home. You can find more information at intensivecareathome.com. But the reality also is that it is a fork in the road, and if you take the wrong turn, the loved one might never return to a quality of life that is acceptable to you and your family.

Number 2. They don’t tell you how hard it may be to reverse. They’ll tell you we can take the tracheostomy out later, but sometimes they don’t. Why? Because once the ICU hands your loved one over to a step-down unit or to an LTAC, again, LTACs are only for our viewers in the United States, the weaning process often stalls. You need to insist on a clear weaning plan before the tracheostomy is even done. This is really where the rubber hits the road.

What is the plan to avoid the tracheostomy? What is the plan for getting your loved one off the ventilator and avoid the tracheostomy at all costs? What are their sedation goals? What sedation is your loved one on? What opiates is your loved one on? Because being on sedation and opiates, that can stall ventilation weaning.

Is your loved one on pressure support ventilation already, which means is your loved one having spontaneous breathing trials already? If they cannot give you clear answers, they’re probably just trying to move your loved one out of ICU, not necessarily improve the outcome.

Again, there are differences between different countries, I would say this. In the United States, a tracheostomy often means they want to send your loved one out to a long-term acute care facility. In other countries such as Australia or the U.K., and many other European countries, a tracheostomy can really be the next step to wean your loved one off the ventilator. But it doesn’t matter which country that you’re in. The best plan is to avoid the tracheostomy and get your loved one off the ventilator and the breathing tube, full stop.

Number 3. It is often about beds, not patients or their family. Let’s not sugarcoat this. ICU beds are valuable real estate. If your loved one is not waking up quickly or has neurological issues, ICU teams will push for tracheostomy to potentially move them out. This is resource-driven, not always patient-driven. If you don’t speak up, you’re just another number.

Next, number 4. Families sometimes get bullied into saying yes. You’ve heard it before. If you don’t do a tracheostomy, they’ll die. If you do a tracheostomy, they might get better. But what they’re really doing is cornering you emotionally. They’ll give you the illusion of choice, when in reality, they’re steering you towards the path that’s most convenient for them, and not necessarily what’s best for your loved one. They want to make it your idea.

Also, when they’re trying to corner you emotionally and psychologically, keep in mind that whatever they’ve done to this point, you’re probably very grateful for that and so you should.

There’s a lot of good things happening in ICU, but there are also not so good things happening in ICU, which is what we’re focusing on today. So, keep the psychological dynamics in mind. You will feel gratitude for everything they’ve done to this point to keep your loved one alive. By you feeling gratitude, you are more likely to give in to their demands. Don’t fall into that trap. Do not fall into that psychological trap. You need to advocate for what’s best for your loved one.

At intensivecarehotline.com, we’ve helped hundreds of families get what they want; push back, delay tracheostomies, get their loved ones weaned off the ventilator, and in some cases, get their loved ones weaned off the ventilator without a tracheostomy. Again, this is where we come in with a second opinion and guide you step by step and sometimes guide the ICU team step by step.

Lastly, number 5. Tracheostomy without neurological recovery is a trap or might be a trap. I should say, if your loved one has had a brain injury, hypoxia, stroke, cardiac arrest, and they’re not waking up, doing a tracheostomy could mean you’re signing up for long-term care with no perceived meaningful recovery. But this can also be a trap because this might be the words they’re putting into your mouth. This is the part ICU teams may not talk about or may almost never talk about.

Ask them, what’s your loved one’s neurological prognosis? Have they had an EEG (electroencephalogram) and an MRI (Magnetic Resonance Imaging) scan or a CT (Computed Tomography) scan? Are they waking up to command? Are they breathing spontaneously at all? If not, the tracheostomy could lead down the path of prolonged suffering, both for patients and for families. But again, just because there’s no meaningful recovery in sight right now doesn’t mean there may not be meaningful recovery down the line. Sometimes, it simply takes time and effort. You have to weigh up the pros and cons.

One thing that I always say is, just because things are not improving today doesn’t mean they’re not improving tomorrow. If they’re not improving tomorrow, they might improve in 2 months’ time, you just don’t know. One thing is for sure, if you let your loved one die, you know the outcome. There’s no return from that as far as we know. Keep that in mind.

So, weigh up your options. Look at options such as intensivecareathome.com as well, where you can take your loved one with a tracheostomy including for palliative care.

Here is what you should do next.

Number 1. Get a second opinion. We provide them at intensivecarehotline.com every day of the week for families in intensive care all around the world.

Number 2. Request a family meeting with the ICU staff and come prepared with your questions. Push for a timeline and plan. Don’t agree to a tracheostomy without a clear path and care plan forward. Call us, of course. Don’t try to fight this system alone. You’ll be outnumbered and out informed. That is what we are here for.

We helped families in intensive care make informed decisions, get peace of mind, and take control so that you’re not being pushed into choices that could change your loved one’s life forever for the worse.

So, go to intensivecarehotline.com now, call us on one of the numbers on the top of our website. Time is critical. Let’s talk today.

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Thank you so much for watching.

This is Patrik Hutzel from intensivecarehotline.com, and I will talk to you in a few days.

Take care for now.

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Quick Tip for Families in Intensive Care: Pressure from the ICU Team to Discontinue Care for My Dad! Quick Tip for Families in Intensive Care: Mom’s Been on Ventilation, Lowest Settings for 21 Days and We’re Being Pressured to Do Tracheostomy. Case Study: How We Successfully Advocated to Extubate a Patient in ICU and Avoid a Tracheostomy! Another intensivecarehotline.com Success Story: How to Keep Your Ventilated Loved One Out of LTAC (Long-Term Acute Care)! Quick Tip for Families in Intensive Care: The UK NHS (National Health Service) Wants to Withdraw Life Support on My 46-Year-Old Brother Without Family Consent! Help!