Quick Tip for Families in ICU: Tracheostomy After 7 Days on a Ventilator in ICU: Right Timing or Too Early?

My name is Patrik Hutzel from intensivecarehotline.com with another quick tip for families of critically ill patients in intensive care, where we help you to 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.

Today, I want to answer a question from one of our members who says.

Today, I happened to discuss with one of the intensity doctors by the name of Raza at the hospital.

He was saying like weaning off a ventilator is going to be difficult, as my mom is in a limited consciousness state. She cannot handle her secretions. He was giving me the option whether my mother would like to have a tracheostomy and then weaning and then moving to a long-term acute care nursing facility. I said yes to it.

I’m a bit frightened and concerned that medical professionals are rushing to move her out of ICU. They’re not trying to just wean off the ventilator without the tracheostomy. Today, It’s the 7th day of a ventilator support.

She seems to have done spontaneous breathing trials for about a couple of hours for the past 3 to 4 days. Do you think they have to delay the tracheostomy? They’re making plans to do a tracheostomy tomorrow in the feeding tube the following day.

Is this a good approach for her going forward as she is minimally responsive and not having much success with straight meaning of process?

Now, here’s my take on this. A tracheostomy after 7 to 10 days of ventilation in ICU is usually standard practice if a patient can be weaned off the ventilator and the breathing tube.

Why? Because the tracheostomy is much more comfortable than having a breathing tube in the mouth. It reduces the need for sedation, which is critical for recovery and assessing brain function.

It also reduces the need for opiates. It is also critical for recovery and assessing brain function. Opiates are medications such as morphine, fentanyl, oxycodone, OxyContin, and sedation is usually propofol, propofol, midazolam/Versed, Precedex.

A tracheostomy also helps with secretion management, especially if your loved one is minimally responsive and can’t cough effectively. Now, your concern about ICU rushing to transfer your mother out to an LTAC (Long Term Acute Care) is valid.

ICUs often want to free up beds quickly, but you and your family are in control here, not the ICU. And obviously, this is from one of our members in the US because if an ICU wants to transfer a patient to an LTAC, that is unique to the United States.

LTAC stands for long-term acute care facility or long-term acute care hospitals. And often when ICUs are trying to send patients to LTAC, it means they end up with a tracheostomy with the PEG (Percutaneous Endoscopic Gastrostomy) tube  and then they want to send them out, but we strictly advise against that.

Your mom has tolerated spontaneous breathing trials for a few hours, which shows some potential, but not enough yet. In such cases, a tracheostomy is often the right step because it avoids repeated reintubations, which are dangerous and traumatic. So, is this the right approach? Based on what you’ve shared.?

Yes, a tracheostomy is a reasonable step forward if extubation attempts are failing, but you also need to clarify, will she stay in ICU for weaning or are they planning to ship her off to a long-term care facility too quickly.

A feeding tube, a PEG (Percutaneous Endoscopic Gastrostomy) tube, is not a reasonable step, because (1) it’s another unnecessary surgery, (2) the perception in hospitals about PEG tubes is simply that a patient will never eat and drink again.

Now think about it, is that the perception you want for your loved one? Whereas if they stay with the nasal gastric tube, the perception is that it’s temporary and that your loved one will need to start eating and drink again.

Which means the efforts the ICU team will be making towards weaning and towards, removing the tracheostomy are much bigger, and there’s a higher chance for success.

You don’t want to put your loved one in a compromising situation where all of a sudden, your loved one gives the perception to the ICU team that they will never eat and drink again. Not a good place to start off with.

The bottom line, a tracheostomy is often the safer option after 7 days of ventilation, when weaning hasn’t worked, especially in someone who’s minimally responsive.

But no, don’t let them rush into a transfer to an LTAC ever, Because the LTAC is simply a disaster area. I’ve made a video about 10 reasons why LTACs are a scam, and I will link towards that video.

Also, go and check out another video that I’ve made, how to wean a critically ill patient off the ventilator and the breathing tube, because the goal always needs to be to try and avoid the tracheostomy  with the 7-to-10-day window.

Now, don’t get me wrong, the tracheostomy has its time and its place, but you need to be absolutely sure that number one, the ICU has done everything beyond the shadow of a doubt to get your love of the breathing tube and the ventilator  and avoid the tracheostomy

How can you find out if they are doing everything beyond the shadow of a doubt. Well, I’m glad you’ve asked, because that’s how we help you.

Because if you go to intensivecarehotline.com, go and book a call with me. if the free tips here are already helping you, imagine how much quicker you can get results if I work with you one and one. It can literally cut the time to life saving outcomes down from weeks to hours.

I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse manager for over 5 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. You can verify that on our testimonial section at intensivecarehotline.com. You can verify it on our intensivecarehotline.com podcast section where we have done client interviews because 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 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.

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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.