Quick Tip for Families in ICU: Why Hemoglobin Levels Matter for Tracheostomy Collar Trials in ICU?

“Why hemoglobin levels matter for tracheostomy collar trials in ICU?”

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 so that your loved one gets best care and treatment always, even if you’re not a doctor or a nurse in intensive care.

So, today’s question is from John, who says,

“Hi Patrik,

My father is now tracheostomy collaring. The ICU probably doesn’t want to do a tracheostomy collar if hemoglobin is under 7. Do you have any thoughts on that?”

For context, John’s father had multiple strokes, he’s got seizures, and he’s also got a PEG (Percutaneous Endoscopic Gastrostomy) tube. He’s been suffering from this condition for multiple years. He’s a chronic patient, and he has gone in and out of ICU for a number of years.

So now, John, that’s a great and very important question that I know other families in intensive care will benefit from as well. Let’s look at this step by step.

What is tracheostomy collaring? Tracheostomy collaring or tracheostomy collar trials is when a patient with a tracheostomy is taken off the ventilator and allowed to breathe through a tracheostomy mask or humidified oxygen. It’s a critical step in weaning someone off the ventilator with a tracheostomy.

So, why does hemoglobin matter? Hemoglobin carries oxygen in the blood. If hemoglobin is too low, generally speaking, under 7g/dL, it means the body and organs are not getting enough oxygen delivered. If someone like your father who has had multiple strokes, seizures, and has a PEG tube, oxygen delivery is absolutely critical. Low hemoglobin can make tracheostomy collaring or tracheostomy mask, or sometimes it’s even called a tracheostomy shield, much harder, increase fatigue, worsen brain oxygenation, and even make seizures more likely.

So what is, generally speaking, ICU practice around hemoglobin and tracheostomy collaring? In most ICUs, if hemoglobin drops below 7, the patient will get a blood transfusion, especially if they’re symptomatic or struggling with weaning when they’re going on the tracheostomy collar. Some patients can tolerate levels under 7, but for complex cases like your father’s, that’s often too risky. That’s why the ICU is probably hesitant to push forward with tracheostomy collaring, unless hemoglobin is optimized and that really can only happen with a blood transfusion.

So, what does that actually mean for your father? Well, the ICU team may need to get a transfusion before continuing tracheostomy collar trials. Close monitoring during tracheostomy collaring is essential. Oxygen levels, heart rate, seizures, ABGs (arterial blood gases), all may need to be tracked. Going slow is better than rushing. Starting tracheostomy collaring too soon with low hemoglobin increases the risk of setbacks.

So John, you should ask the ICU team, what’s his current hemoglobin trend, and where is the drop in hemoglobin coming from? Is it a bleeding issue? Is he bleeding internally? Is his bone marrow suppressed? Is his immune system suppressed? Is that why hemoglobin is dropping down? Do they plan to transfuse a unit of packed red blood cells before more tracheostomy collaring attempts? How are they monitoring him during the tracheostomy collar trials? How are they finding out the cause of the low hemoglobin? Are they getting hematology involved as the specialists?

This way you can advocate for your father’s best chance at successful weaning from the tracheostomy. I hope that helps.

If you have a loved one in intensive care and you need help making sense of what’s happening, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website, or send us an email to [email protected].

I offer one-on-one consulting advocacy for your loved one and for your family in intensive care so that you can make informed decisions, have peace of mind, control, power, and influence, make sure your loved one gets the best care and treatment always, even if you’re not a doctor or a nurse in intensive care.

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.

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, if you 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 questions intensive care related. In the membership, you also have exclusive access to 21 eBooks and 21 videos that I have 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 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.

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

I also do a weekly YouTube live where I answer your questions live on the show. You will get notification for the YouTube live if you are a subscriber to my YouTube channel or my intensivecarehotline.com email newsletter at intensivecarehotline.com.

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.

Related Articles:

Quick Tip for Families in ICU: Why You Need to Talk to the Medical Specialists Outside of ICU! Quick Tip for Families in Intensive Care: How Long to Wake Up After Multiple Gun Shots in ICU? Quick Tip for Families in Intensive Care: Five Ways to Position Yourself if Your Loved One isn’t Waking Up After an Induced Coma! Quick Tip for Families in ICU: My Wife’s in ICU and I Can’t Get Information From the Doctors, Help! Quick Tip for Families in ICU: Not Knowing if I’m Doing All I Can & the Best for My Loved One in ICU