My name is Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care, 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, control, power and influence, making sure your loved one always gets the best care and treatment, even if you’re not a doctor or a nurse in intensive care.

One of the questions I often get from families is, can one demand a tracheostomy or can we insist the intensive care unit (ICU) team perform a tracheostomy on my loved one?

It’s a really important question, and the short answer is technically you cannot demand a tracheostomy, but you absolutely have the right to advocate, question and influence medical decisions in intensive care, and that’s what we’ve been doing for 15 years now, advocating and getting results for families in intensive care, including advocating for a tracheostomy.

Let me explain this in detail so you understand your rights, your options, and how to get the best outcome for your loved one.

First of all, you need to understand medical decision making in ICU. Let’s be clear about something, medical decisions in ICU are meant to be collaborative, not one-sided. While doctors have the medical expertise and ultimately make clinical decisions, families have rights and your voice matters enormously.

A tracheostomy is a surgical procedure that creates an opening in the neck to place a tube directly into the windpipe. It’s often done when patients need prolonged ventilation to make them more comfortable, improve weaning prospects or facilitate long-term care. However, doctors may not want to perform a tracheostomy simply because a family demands it; they need to believe it’s medically appropriate, safe, and in the patient’s best interest.

So when is a tracheostomy appropriate? A tracheostomy might be recommended when your loved one needs prolonged mechanical ventilation, usually beyond 10 to 14 days. There’s potential for weaning from the ventilator, but it will take time to improve comfort and reduce sedation and opiates compared to an endotracheal tube or a breathing tube in the mouth. To reduce ICU acquired complications like ventilator-associated pneumonia (VAP), to facilitate transfer to a step-down unit or long-term care facility, when there’s a plan for long-term ventilation outside of ICU such as with Intensive Care at Home, and you can get more information at intensivecareathome.com.

So, why you simply can’t demand one? The reality is doctors must follow medical ethics and standards of care. If they believe a tracheostomy would be futile, harmful or not in the patient’s best interests, they can decline to perform it. This might happen if the patient is too unstable for surgery. The prognosis might be perceived as extremely poor with imminent death expected. There are contraindications like severe bleeding disorders. The patient has advanced directives against invasive procedures, or if ventilator settings have not been reduced to a level where a tracheostomy is safe, for example, if positive end-expiratory pressure (PEEP) is above 10, pressure control is above 15 to 20, high fraction of inspired oxygen (FiO2) levels from the ventilator higher than 40%, a tracheostomy cannot be performed yet.

However, just because you can’t demand it doesn’t mean you’re powerless. You also can’t demand it if there’s no medical indication whatsoever. There have to be checks and balances. But here is how to advocate effectively for tracheostomy, because this is where having the right information and the right support makes all the difference.

Number one, get access to all medical records. You need to understand the full clinical picture. Request and review daily ICU progress notes, ventilator settings and weaning parameters, lab results and imaging reports, fluid balance charts, medication charts, consultant notes and recommendations, nurses’ reports, and physiotherapy reports. Leave no stone unturned. Having access to all medical records is crucial because it allows you to ask informed questions and understand why the ICU team is making certain recommendations, or why they’re not recommending a tracheostomy when you think they should.

Next, schedule a consulting call with intensivecarehotline.com. This is where me and my team come in. A consulting call with myself or the intensivecarehotline.com team can be a game changer. We review medical records with you so you understand what’s really happening, prepare you with the right questions to ask the ICU team, help you understand whether a tracheostomy is appropriate in your loved one’s case, join you on a call with the ICU team to question, clarify and advocate effectively, and challenge the medical team respectfully when decisions don’t make sense.

Many families tell us that after working with us, the ICU team suddenly becomes more responsive, more willing to consider options like a tracheostomy or other treatment options, and more collaborative in decision making. Because we help you advocate from a position of knowledge and confidence, and you can verify that confidence on our testimonial section at intensivecarehotline.com, where we have hundreds of testimonials from our clients. We have interviews in our podcast section with clients who verify that we helped them to save their loved ones’ lives. We have saved hundreds of lives in intensive care with our consulting and advocacy, and it’s all documented.

Next, ask the right questions. When discussing tracheostomy with the ICU team, ask: What are the specific criteria you’re using to decide about tracheostomy timing? What are the risks and benefits in my loved one’s specific situation? What is the plan for weaning from the ventilator? If we don’t do a tracheostomy now, what’s the alternative plan? Are there any contraindications preventing you from doing it now? What would change your mind about performing a tracheostomy?

And get a second opinion, which you can get from us at intensivecarehotline.com. Especially if you feel the ICU team is being unreasonable or you’re getting mixed messages, you have the right to request a second opinion either from another intensivist in the hospital or from an external expert, and that can be us here at intensivecarehotline.com. We help facilitate this and make sure you’re getting objective, evidence-based advice.

Also, what if your loved one needs long-term ventilation with a tracheostomy? Here’s something most families in intensive care don’t know. You don’t have to keep your loved one in ICU indefinitely if they need long-term ventilation and a tracheostomy. This is where intensivecareathome.com becomes critically important. Intensive Care at Home is a long-term option to keep tracheostomy and ventilation adults and children out of ICU predictably and permanently. If your loved one needs long-term mechanical ventilation, ongoing tracheostomy care, complex medical management, or end-of-life care in a dignified, comfortable setting, many families don’t realize that with the right support, their loved one can be cared for at home or in a specialized facility with 24/7 intensive care nursing, proper equipment and medical oversight.

This option provides much better quality of life than staying in ICU, reduces hospital-acquired infections, gives families more control and involvement in care, is often more than 50% more cost effective than an ICU bed, allows for dignified end-of-life care if recovery isn’t possible, and all of our clients for Intensive Care at Home have community access. If the ICU team is hesitant about tracheostomy because they’re worried about long-term placement, intensivecareathome.com provides the solution.

The bottom line, can you demand a tracheostomy? No, not technically. But you and we can advocate effectively, question decisions and influence the ICU team to consider tracheostomy when it’s appropriate. Absolutely yes, we’ve done it hundreds of times. We have saved so many lives in ICU with our consulting and advocacy, and it’s all documented.

The key is having access to all medical records, getting expert support from intensivecarehotline.com, asking the right questions and challenging decisions that don’t make sense, knowing your options including long-term care through intensivecareathome.com, by sending your critical care nurses 24 hours a day in a family-friendly and patient-friendly environment for half of the cost of an ICU bed, meaning insurance agencies and funding bodies have an interest in that.

Never accept no without understanding why. Don’t let the ICU team make decisions in a vacuum without your input. You have rights, you have options, and you have us to support you.

Take action now. If you’re facing this situation and you need help, call me at intensivecarehotline.com for a consulting call, or email your loved one’s situation and medical records to [email protected], and visit intensivecareathome.com to learn about long-term ventilation options and ICU care at home.

We’ve helped thousands of families navigating these exact decisions and saved countless lives with our services, whether it’s intensivecarehotline.com or Intensive Care at Home. We advocate effectively and get the outcomes you want for your loved ones.

Don’t wait. The decision you make now will change everything.

I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over five years in intensive care. I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives with our consulting and advocacy, because of our insights, and you can verify that on our testimonial section at intensivecarehotline.com and on our podcast section where we have done client interviews. Our advice is absolutely life-changing.

The biggest challenge for families in intensive care is simply that they don’t know what they don’t know. They don’t know what to look for, they don’t know what questions to ask, they don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. That’s why we help you to improve your life instantly, making sure you make informed decisions, have peace of mind, control, power, and influence, making sure your loved one gets the best care and treatment always.

That’s why you can join a growing number of members and clients that we have helped over the years, saving their loved ones’ lives. That’s why I do one-on-one consulting and advocacy over the phone, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through this once-in-a-lifetime situation that you simply cannot afford to get wrong. When I talk to families directly, I also talk to doctors and nurses directly, asking all the questions that you haven’t even considered asking but must be asked when you have a loved one critically ill in intensive care.

I also represent you in family meetings with intensive care teams. We also do medical record reviews in real time so that you can get a second opinion in real time. We also do medical record reviews after intensive care, in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

We also have a membership for families of critically ill patients in intensive care, and you can become a member if you go to intensivecarehotline.com and click on the membership link, or if you go to intensivecaresupport.org directly. In the membership, you have access to me and my team 24 hours a day in the membership area and via email, and we answer all intensive care-related questions. In the membership, you also have exclusive access to 21 e-books and 21 videos that I’ve personally written and recorded. All of that will help you to improve your life instantly, make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets the best care and treatment, always. All of that you get at intensivecarehotline.com.

Call us on one of the numbers on the top of our website or simply send us an email to [email protected] with your questions.

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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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