“Hypoxic brain injury after code: Can my sister come home with tracheostomy, ventilation, and (Percutaneous Endoscopic Gastrostomy) tube?”

My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies, where we provide tailor-made solutions for long-term ventilated adults and children on BIPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure), home tracheostomy without ventilation, home cough assist, home ventilation weaning, Home TPN (Total Parenteral Nutrition), home IV potassium, home IV magnesium, home IV antibiotic infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, port management at home, nasogastric, nasojejunostomy, PEG tube, and PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home, as well as palliative care management at home.

Today, I have an email from Linda, who says:

“Hi Patrik,

I’m considering Intensive Care at Home because she has a hypoxic brain injury due to a cardiac arrest incident in the hospital.

She is in a step-down ICU or HDU (high dependency unit) and they have already put in a tracheostomy and a PEG tube. There is no discharge plan. She requires a very high level of care.

How long will it take to treat the hypoxic brain injury? Can the tracheostomy be removed? Can she be discharged home with a tracheostomy?

I really don’t know what to do. Please help. What are our options?

From, Linda.”

Thank you, Linda, for reaching out about your sister’s situation. So let’s just start with understanding your sister’s situation: hypoxic brain injury, tracheostomy and PEG.

First of all, I can hear your concern and uncertainty in your message, and I want you to know that you’re not alone. Many families face this exact situation in ICU after a loved one experiences a cardiac arrest/code incident in the hospital that leads to a hypoxic brain injury, prolonged ICU stay, prolonged ICU admission, tracheostomy, PEG tube ventilation.

But let me break down what’s happening with your sister, and most importantly, what your options are, including bringing her home with Intensive Care at Home.

So, what is a hypoxic brain injury and why did it happen? A hypoxic brain injury occurs when the brain doesn’t get enough oxygen for a period of time. In your sister’s case, this happened during a “code” incident in the hospital, which typically means she had a cardiac arrest or respiratory arrest where the heart stopped beating or she stopped breathing.

During a code, even though the medical emergency teams usually work quickly to resuscitate the patient, there can be minutes where the brain isn’t getting adequate oxygen. The brain is extremely sensitive to oxygen deprivation, and even a few minutes without oxygen can cause significant brain injury.

The severity of hypoxic brain injury can range from mild to severe depending on:

• How long the brain was without oxygen
• How quickly resuscitation was achieved
• The patient’s overall health before the code
• How well the brain was protected during and after the cardiac arrest or respiratory arrest event

So then, why does your sister have a tracheostomy and a PEG tube? The ICU has placed a tracheostomy and a PEG tube in your sister because of the complications from her hypoxic brain injury.

The tracheostomy is a surgical or percutaneous opening into the neck that goes directly into the windpipe or trachea and directly into the lungs. It is used instead of a breathing tube through the mouth when a patient needs long-term ventilation support, protection of the airway, help managing secretions, prolonged respiratory support during recovery, which includes suctioning, for example.

After a hypoxic brain injury, many patients need a tracheostomy because they can’t protect their own airway, they have difficulties swallowing, they need ventilation support, or they’re not waking up quickly enough to breathe on their own.

The PEG tube, also known as percutaneous endoscopic gastrostomy, is a feeding tube that goes directly into the stomach through the abdominal wall. It is used when a patient can’t swallow safely, is at risk for aspiration, needs nutrition but can’t eat by mouth, and requires long-term feeding support. After a hypoxic brain injury, swallowing function is often impaired, so a PEG tube ensures your sister gets proper nutrition while her brain heals.

How long will it take to treat a hypoxic brain injury? This is the question every family asks, and unfortunately, there’s no simple answer. The recovery timeline for hypoxic brain injury varies dramatically from patient to patient.

Factors that affect recovery time are, of course:

• The severity of the injury: Mild hypoxic brain injuries may improve in weeks to months while severe injuries can take months to even years, and some patients may have permanent deficits, unfortunately.
• Areas of the brain affected: Different parts of the brain control different functions. The location and extent of injury affects what functions are impaired and how long recovery takes.
• Age and overall health: Of course, younger, healthier patients generally recover better and faster than older patients or those with multiple health problems.
• Quality of rehabilitation: Intensive specialized rehabilitation makes a significant difference in outcomes and recovery speed.

What’s the time frame or a realistic time frame for hypoxic brain injury recovery?

• First 3 months: This is when most dramatic improvements occur. The brain is in acute recovery mode.
• 3 – 6 months: Continued improvement is common, though at a slower pace.
• 6 – 12 months: Some patients continue to show improvements, especially with intensive therapy.
• Beyond 12 months: Recovery can still occur but improvements become smaller and slower. However, some patients continue to improve for years with the right support and therapy.

The truth is, no one can predict exactly how your sister will recover. Some patients surprise everyone and recover far better than expected, while others plateau earlier than hoped. What’s critical is that your sister gets the best possible care, therapy, and environment to maximize her recovery potential.

Can the tracheostomy be removed? Yes, absolutely! Tracheostomy can be removed in many cases, but the time limit depend depends on several factors.

When can a tracheostomy be removed? I’ve made countless of videos about that topic, but a tracheostomy can typically be removed when:

• The patient can breathe independently without ventilator support.
• The patient can protect their own airway (cough effectively, manage secretions)
• The patient can swallow safely without significant aspiration risk.
• The underlying reason for the tracheostomy has resolved.
• The patient is medically stable.

For patients with a hypoxic brain injury, tracheostomy removal depends on neurological recovery. As your sister’s brain heals, she may regain the ability to breathe on her own, protect her airway, and manage secretions. At that point, the tracheostomy can be removed.

However, some patients with severe hypoxic brain injury may need a tracheostomy long-term or even permanently if they require ongoing ventilation support, can’t protect their airway, have severe weakness of breathing muscles, and continue to have high secretion loads they can’t manage.

The good news is that even if your sister needs a tracheostomy long-term, she can still come home with Intensive Care at Home.

So, can your sister be discharged home with a tracheostomy? Yes, this is exactly what Intensive Care at Home specializes in! Many families don’t realize that a patient with a tracheostomy, even one who requires ventilation support, can be safely discharged home.

with the right setup, equipment, staff and support.

This is backed by evidence-based medical guidelines, in fact, the evidence-based Mechanical Home Ventilation Guidelines, that you can find on our website at intensivecareathome.com, outline exactly how patients with tracheostomies and ventilators can be safely managed at home, that includes equipment but also staffing requirements such as 24-hour critical care nurses.

It can’t be anything less than that because according to these evidence-based guidelines, mechanical ventilation with or without a tracheostomy, it’s not only safe but often better for patients than staying in ICU or in a step-down ICU when there’s 24 -our intensive care nursing at home.

1. It offers a much better quality of life: Patients are in their own homes surrounded by family in a familiar environment and in control of their destiny.
2. There’s a much lower infection risk: Hospitals, ICUs, and facilities have high rates of hospital acquired infections. Home is the much safer option.
3. More personalized care: At home, your sister gets one-on-one attention from trained caregivers who know her and care about her, i.e. our ICU nurses are the caregivers that really can keep your sister at home predictably and permanently.
4. Better outcomes: Studies show that patients with 24-hour intensive care nursing at home often do much better with proper support than in institutionalized settings.
5. Last but not least, it is much more cost effective: Intensive Care at Home is significantly less expensive than prolonged ICU or step-down ICU stays. As a matter of fact, it’s probably around 50% less than the ICU or step-down ICU stay.

So, what does Intensive Care at Home provide? When you choose Intensive Care at Home for your sister, we provide everything needed to safely discharge your sister from ICU to home and to keep her home permanently and predictably.

We help you with a complete home setup. All medical equipment including ventilation, suction machines, oxygen, and monitors. We can help you with hospital beds and positioning equipment, emergency backup equipment, all supplies for tracheostomy care, PEG feeding, and medical needs. Of course, the most important ingredient here is 24-hour intensive care nurses. Because our intensive care nurses are trained on ventilation and tracheostomy, and also on PEG tubes. They’re trained on emergency procedures, they’re trained on positioning, turning and basic care.

We coordinate with doctors and other specialists, regular equipment checks and maintenance, care coordination to coordinate our team. We also work with the hospital for safe discharge. We coordinate with funding bodies whether it’s insurance, NDIS  and so forth. We can help you set up physical therapy at home, occupational therapy, speech therapy, manage medications and supplies, ongoing rehabilitation such as physical therapy at home to prevent complications and maximize recovery. Occupational therapy for daily living skills, speech therapy for swallowing and communication, neurological rehabilitation specific to brain injury recovery.

Also, why is there no discharge plan for your sister? You mentioned that your sister is in a step-down ICU/HDU (high dependency unit) and there’s no discharge plan. That’s not only extremely common and it’s one of the biggest frustrations families face.

So, why hospitals often have no discharge plan? They assume the patient needs a nursing home or a long-term acute care facility, which would be absolutely futile to your sister’s care. In many cases, ICUs often don’t consider Intensive Care at Home as an option for complex patients with tracheostomies and high care needs, even though we’ve been successfully providing this service since 2012. They’re not aware of home ventilation options. Many hospital case managers and social workers or ICU professionals don’t even know about our specialized program with Intensive Care at Home.

Also, there are sometimes real or perceived insurance barriers, so what that means is hospitals sometimes believe insurance won’t cover home care for complex patients, which is often not true. Because if it wasn’t true, we wouldn’t be existing as a business.

Lack of coordination: Discharge planning  for complex patients requires specialized knowledge and coordination that many hospitals simply don’t have.

Bed pressure: ICUs need beds so they may push for a quick placement in a nursing home, rather than taking time to set up a proper home discharge, and if your sister was to go into a nursing home, she’ll probably die because they wouldn’t be able to look after the tracheostomy.

This is where Intensive Care at Home changes everything. We work with the hospital to create a safe, evidence-based discharge plan that gets your sister home with 24-hour intensive care nursing, instead of letting her go to a nursing home where she will just die.

So, what are your options right now? You have several options for your sister’s care. I want you to understand each one:

Option 1: To keep her in the step-down ICU, let her go to a nursing home. That’s what the hospital may suggest. There’s really no pros besides that there’s medical staff available 24-hours a day, but we can provide the same at home. There’s many more cons to keep her in hospital, which is an institutionalized setting, not home, very high risk of infections, limited family time and involvement, it’s depressing and isolating for patients, can be far away from family and probably won’t provide the intensive rehabilitation.

The best option here, of course, is Intensive Care at Home. This is where your sister comes home with full medical and nursing support with Intensive Care at Home. The pros are bountiful: Your sister is at home with family, personalized one-on-one care with 24-hour intensive care nurses, lower infection risk, better quality of life, family involvement whenever you want to, intensive rehabilitation at home, evidence-based care with the Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com.

It’s covered by insurances or NDIS or whichever funding body you can tap into. The bottom line is, the funding: we have, because we’re cutting the cost of an intensive care bed by 50%, that’s 5-0. We can adjust care as your system improves, dignity and comfort in familiar surroundings.

The only con that I can see really is that sometimes it requires some home modifications, but that is certainly something that can be overcome.

For your sister with hypoxic brain injury, a tracheostomy and the PEG tube, Intensive Care at Home is often the best option because it provides the medical and nursing support your sister needs 24-hours a day while maximizing her recovery and quality of life potential in the best possible environment, which is clearly home.

Like I said, our evidence-based approach at Intensive Care at Home is based on solid medical and nursing evidence, the Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com provide the scientific foundation for safely managing patients like your sister at home with 24-hour intensive care nurses and medical oversight.

The evidence-based guidelines show home mechanical ventilation is safe for appropriate patients with 24-hour intensive care nursing.

Patients can definitely be successfully managed at home with tracheostomies. Home care reduces hospital acquired infections, quality of life is significantly better at home, family involvement improves patient outcomes, home care is cost effective compared to institutional care, and proper training and proper staff selection with 24-hour intensive care nurses makes all the difference. It’s not experimental, it’s not risky— it’s evidence-based, backed by millions of hours of intensive care nursing that we have by now delivered for hundreds of patients all over the world.

So, what should you do next? If you’re considering Intensive Care at Home for your sister, here are the specific next steps:

1. Contact me at com immediately.

Fill out the contact form or send us an email to [email protected], or call me on one of the numbers on the top of our website. Time is critical because the longer your sister stays in ICU, the harder it becomes to bring her home, and she’s at high risk of infections.

2. Gather your sister’s medical records.

We’ll need information about your sister’s current condition, medical records and progress notes, information about her ventilation settings (if she’s on a ventilator), tracheostomy type and size, PEG tube information, current medications, level of consciousness and neurological status, any other medical issues.

3. Schedule a consultation.

Like I said, contact me today.

4. Start the discharge planning process.

Then, once we know that Intensive Care at Home is definitely appropriate for your sister. We begin working with the hospital, coordinating the discharge, coordinating with insurance about funding, arranging equipment and supplies, and planning for training and support.

5. Prepare your home.

We can help you prepare your home, hire the intensive care nursing team, and then make a safe discharge home.

6. Safe Discharge Home

We coordinate all of that, with all equipment, supplies and the team in place.

7. Ongoing Support and Care

Once your sister is home, we provide the 24-hour intensive care nurses, monitoring, and any adjustments to care as needed, and coordination with all medical providers because your sister deserves the best chance of recovery.

A hypoxic brain injury is devastating, but at least a partial recovery is possible with the right care, therapy, and environment. Your sister deserves to be home surrounded by people who love her in a comfortable and familiar setting where she can maximize her recovery potential. Tracheostomy might be able to be removed as she recovers, no guarantee of course, but even if she needs it long-term, she can still be at home.

So take action today, subscribe to my YouTube channel for more information, and send us an email and give me a call on one of the numbers on the top of our website.

Remember, Linda, you’re not alone in this, we’re here to help you every step of the way.

Now, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24-hours a day. We are providing the following:

• Home care services for ventilated adults & children with tracheostomies with critical care nurses 24-hours a day
• Genuine alternative to a long-term stay in intensive care or at long-term acute care
• Tracheostomy care for clients without ventilation
• Home care services for patients on non-invasive ventilation, such as Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure)
• Home TPN (Total Parenteral Nutrition, which is also known as IV nutrition
• Home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics
• Providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home.
• Providing nasogastric tube and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home
• Use cough assist machines for our clients for airway clearance at home
• Palliative care services at home
• Ventilator weaning at home

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home, instead of them going to an emergency department.

That also means, we’re also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs between $5,000 to $6,000 per bed day. Our services costs between $2,500 to $3,000 per bed day, and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. Most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders. Of course, quality of life is much improved surrounded by families and by a team of dedicated intensive care nurses in the home care setting instead of in an intensive care unit.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We work with NDIS (National Disability Insurance Scheme) clients all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, Department of Veteran Affairs (DVA) all around Australia. Our clients and we, as a service provider, have also received funding through public hospitals, private health funds, as well as Departments of Health.

We are having policies and procedures for Intensive Care at Home nursing and we’ve built all the intellectual property for Intensive Care at Home since 2012. No other provider in Australia has created more intellectual property when it comes to Intensive Care at Home nursing than we have. This puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2025 employs a higher skill level in the community than we do, which enables us to look after the highest acuity adults and children in the community in Australia safely.

If you’re at home already and you’re watching this, or you’re stuck in an ICU long-term, or if you’re going to the hospital and ED all the time, and you realize that you don’t have the right level of support at home, or if you are stuck in an ICU, I’ll give you a real-world example today, how we can help you.

One of our first clients when we first got started in 2012, was a client who was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers are not equipped to look after a client at home on a ventilator with a tracheostomy. That is dangerous and it’s simply negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy is like flying the airplane with a cabin crew instead of the pilot. Because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies 24/7, or even at high risk of dying if they don’t have a team of dedicated critical care nurses looking after them 24/7 at home. This is actually evidence-based and is documented in our Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com.

Think about it, in an intensive care unit in a hospital, you wouldn’t have support workers looking after your critically ill loved one or after any critically ill patient on a ventilator with a tracheostomy. So, why would anyone in their right mind do that in the home care environment in the community?

So, this client at the time found out about us eventually, and the ICU that he was basically living in also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with this particular client, we sent him critical care nurses, 24-hours a day. He never ever went back into ICU ever again, as long as we were working with this client.

We can do the same for you if you’re not safe at home and help you with keeping you at home predictably. Otherwise, we would not be in business. Again, the same is applicable for those stuck in an ICU, similar to this case study that I’ve just given you, or if you’re going back to ED all the time, please reach out to us. We can help you with taking you through the right steps, including how to get funding with different funding bodies.

This is also why we are providing NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS support coordinators, and I’ll put a link to an interview with Amanda in the written version of this blog. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

If you’re an NDIS support coordinator or a case manager from another organization watching this, and you’re looking for nursing care for your participants, please reach out to us as well. If you need more evidence for nursing care, we are also writing NDIS nursing assessments with legal nurse critical care consulting nurses.

If you are a critical care nurse and you’re looking for a career change and you want to join a very progressive, dynamic, and high performing team of critical care nurses in the community, we’re employing hundreds of years of critical care nursing experience combined. You can join this high performing team if you are a critical care nurse.

If you are looking for a career change as a critical care nurse, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I do have a disclaimer though, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients also do want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular staff. So, if you’re looking for agency work, where you can come and go, this will not be the right fit for you. We are looking for consistency and our clients are looking for consistency. So please, only apply with us if you can give us regular and consistent availabilities for shifts, and you’re really keen on building solid relationships with us and with our clients.

If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We’re currently expanding our medical team as well. We can also help you eliminate your bed blocks in your ICU and in your ED for your long-term patients, or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help you take the pressure off your ICU and ED beds. In most cases, you won’t even pay for it. Even if you do pay for it, it is so much more cost-effective than what you’re paying for in ICU and ED, and you get the same level of care.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, or for home TPN, please reach out to us as well. We can help you eliminate your bed blocks very fast.

If you’re in the U.S. and in the U.K. and you’re watching this, and you need help, we want to hear from you as well. We can help you there privately with one-on-one consulting and with hiring nurses privately.

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected].

If you like my videos, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care. Click the like button, click the notification bell, share this video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

Thank you so much for watching.

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