Quick Tip for Families in ICU: Tracheostomy vs BCV (Biphasic Cuirass Ventilation) Ventilator in ICU – What ICU Doctors Don’t Tell You!

“Tracheostomy versus BCV (Biphasic Cuirass Ventilation) ventilator in ICU–What doctors in ICU won’t tell you!”

My name is Patrik Hutzel from intensivecarehotline.com, 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, even if you’re not a doctor or a nurse in intensive care so that your loved one always gets best care and treatment.

One of our members, Ann Marie, sent us a question, and by the way, we have a membership for families of critically ill patients in intensive care at intensivecarehotline.com. You can become a member if you go to intensivecarehotline.com and you click on the membership link.

So, I have this question from Ann Marie today, who says,

“Hi Patrik,

My husband is on tobramycin for Pseudomonas, the doctor says he will be on it 28 days on, and 28 days off. It makes him very tired and sleepy, so they are monitoring him for 7 days. He has mittens on his hands, so why do they put a fall risk band on his arm? I am still being pressured to do a tracheostomy, I am exploring the BCV ventilator as an option and alternative to the tracheostomy.

I had mentioned this ventilator to the first doctor and he told me this was not a part of their standard of care. This new doctor is willing to take a look at it. The first doctor was trying to bully me to allow my husband to get the tracheostomy. He came over my husband and was deliberately trying to get his consent and kept saying, if I didn’t stop intervening, he would have the guards put me out. My husband said no!

They gave him no physical therapy or occupational therapy before they tried to extubate him, the first or second time. He was always sedated. The first time they tried to extubate him, they didn’t hold the feeding tube he had on the CPAP (Continuous Positive Airway Pressure) mask, he aspirated and he had to be reintubated and his lungs collapsed. I know this is medical negligence, I asked about a tilt board to help with mobilizing, the physiotherapist states they don’t use this at this hospital and mobility is not a priority here, she said. I will email you the medical records shortly. Thank you.

From, Ann Marie.”

Now, Ann Marie, thank you for your question. Your and your husband’s situation is unfortunately very common in intensive care. Families are often pressured into consenting to a tracheostomy without being given all the options or without doctors, nurses, or physiotherapists following best practice.

Let’s break this down.

1. Tobramycin for Pseudomonas. Tobramycin is a strong antibiotic often being used for resistant bugs like Pseudomonas. Fatigue and sleepiness are known side effects. Monitoring is important, especially for kidneys and hearing.

2. Falls risk band and mittens. Hospitals put a falls risk band on patients as part of blanket protocols. Even if your husband has mittens, it’s a liability measure for them, not a personalized care approach. Maybe if they took off the mittens and they were actually talking to him to be calm, and someone was actually probably looking after him, maybe wouldn’t need the mittens. There’s a high chance that he wouldn’t need them.

3. Tracheostomy pressure versus BCV ventilator, which stands for Biphasic Cuirass Ventilation. Ann Marie, you are absolutely right to explore alternatives like the BCV ventilator. Just because it’s “not their standard of care” doesn’t mean it’s not an option.

Many hospitals and ICUs only push tracheostomies because it fits their systems, protocols, and narratives, not because it’s always in the best interest of the patient. If your husband said no to a tracheostomy, his wishes should be respected. Forcing consent or threatening to remove you from the ICU is bullying and medical negligence.

Now, as you’ve heard me say here before on this blog, a tracheostomy has its time and its place. Whilst I personally don’t have a lot of experience with the biphasic cuirass ventilation, which is, by the way, a non-invasive ventilation technique that uses a portable, shell-like device placed on the chest to create alternating positive and negative pressure, thereby assisting the patient’s breathing by mimicking natural diaphragm movement, doesn’t mean it’s not going to work for your husband, it doesn’t mean that at all. They need to try and see what happens. Like I said, that’s not trying, it’s bullying and medical negligence, and you should escalate this.

Next, let’s look at failed extubations and aspiration. Extubation without proper preparation, without physiotherapy or occupational therapy, without holding the feeding tube, then causing aspiration and collapsed lungs is absolutely poor ICU practice and it is absolute negligence. Extubation should be planned carefully with physiotherapy, chest clearance, and swallowing assessment. By them extubating him without holding the feeds for at least 4 to 6 hours, without taking proper preparation and precautions, is medical negligence. Full stop.

5. Mobility in ICU. Mobility is critical in weaning patients off ventilation. The fact that physical therapy and OT (occupational therapy) wasn’t prioritized, and that they dismissed tilt boards, and that they said that mobilization is not a priority, shows you you’re in an ICU that’s not following best evidence, and that’s not interested in doing what’s in the best interest of the patient, i.e., your husband.

So, here’s what you can and what you need to do:

1. Get access to all medical records.

2. Keep advocating for your husband, you are 100% correct in questioning every step. Push for mobility, physiotherapy, and alternatives like BCV ventilation. Demand transparency in medical records, and we’ll review them once you send them, of course. Don’t let ICU bully you. Their threats show the way they want you to be silent, and not partner with you.

I am very happy to have a chat with hospital executives, with ICU doctors, ICU nurses. We can also help you to write powerful emails to hospital executive to make appropriate complaints and help your husband to get best care and treatment.

Now, once sedation is off, by the way, sedatives and opiates need to be switched off. It sounds like he was extubated on sedation, which is, again, medical negligence. Then, he might actually succeed in extubation. Also, if he’s still too sedated, he’s at high risk of aspiration. If he’s too sedated, the BCV ventilation won’t work, so he needs to be more awake. Once he’s more awake, you can map out the next steps, whether that might be a tracheostomy, or that might be BVC.

First off, he needs to be free of sedation and free of opiates. Just for the records here, sedation often in ICU: propofol, midazolam/Versed, and or Precedex (dexmedetomidine). Opiates often and commonly used in ICU are morphine, fentanyl, sometimes oxycodone, OxyContin.

So, here at intensivecarehotline.com, we help families like yours to have power, control, and influence, making sure your loved one gets best care and treatment always so that you can make informed decisions.

The fact that the free advice here is already helping you should show you how powerful my advice would be if you get on a one-on-one consulting and advocacy call with me, because I can cut the time to life-saving results down to hours, sometimes even minutes.

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.

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 if in case you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

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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.