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Quick Tip for Families in Intensive Care: Dad isn’t Improving on the Ventilator & ICU Says Tracheostomy Not Feasible Despite Advanced Care Plan!

If you want to know what to do when your loved one is not improving on a ventilator in intensive care, stay tuned.

Hi, my name is Patrik Hutzel and I have another quick tip for families in intensive care.

Today, I have an email from Sabrina who says, “My dad is not improving on the ventilator in ICU. He’s intubated. The ICU team says a tracheostomy is not feasible and they’re bucking against his advanced care directive. What should I do?”

I’m very sorry, Sabrina, to hear about your dad’s situation.

Now, here’s the thing. So, obviously, your dad is challenged in ICU here and he can’t come off the ventilator. Now, the intensive care team is telling you that a tracheostomy is not feasible.

Now, there could be a number of reasons why a tracheostomy may not be feasible. One of those reasons is simply that it could be temporarily not feasible. What I mean by that is that he has a PEEP (Positive End-Expiratory Pressure) that’s above 10. He might have oxygen requirements, FiO2 (Fraction of Inspired Oxygen) requirements that are above 50%. His arterial blood gases might be poor on high oxygen levels, high support levels. That means until his underlying issues are fixed, it would be very difficult to do a tracheostomy. So, you have to actually find out why they’re saying a tracheostomy is not feasible.

Furthermore, he might be on high doses of anticoagulation for whatever reason, such as heparin or warfarin or any other anticoagulation that puts him at high risk of bleeding, which also is a contraindication for a tracheostomy. They might be able to stop the anticoagulation for a period of time so they can do a tracheostomy. Other contraindications for a tracheostomy can be that there’s short necks or there’s other physical anatomical deformities that prevent a tracheostomy.

But other than that, from my experience and my experience dates as way back as 25 years in critical care nursing where I worked in three different countries and where I also worked as a nurse manager for over 5 years and where I’ve been consulting and advocating for families in intensive care all over the world since 2013 here at intensivecarehotline.com. So, from my experience, there’s no other contraindications. So, when they’re saying a tracheostomy is not feasible, they might simply be misleading you.

Unfortunately, as much as there’s many good things happening in intensive care all around the world, the families and our clients that we are dealing with, unfortunately, they are challenged on many levels when they have a loved one in intensive care.

You have to verify that what the intensive care is telling you is actually accurate. So, tracheostomy is not feasible, ruling all the other things that I’ve just mentioned, there’s always the option of doing a tracheostomy. Always. I haven’t seen it any other way.

It sounds to me like they don’t want to do a tracheostomy for whatever reason. Maybe they want to play God and think that it’s not in your dad’s interest to live. We hear this almost every day here when families contact us here at intensivecarehotline.com where they say, “The intensive care team is telling me, “Oh, it’s not “in the best interest” of my family member to live.”” Well, that is a whole lot of nonsense in my mind.

It’s not up to intensive care teams to decide who can live and who can die. Everyone needs to be given an opportunity to live and that often means to perform a tracheostomy assuming that’s what patients and families want.

In this particular situation, Sabrina is saying that her dad even has an advanced care directive, i.e., an advance care directive is a legal document. It probably says something along the lines of that your dad wants everything done if he’s ever in a situation like that. Obviously, the intensive care team has different ideas but doesn’t really have a say, and that’s the good thing.

The biggest challenge for them is 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. They don’t know how to manage doctors and nurses in intensive care.

I think that is exactly what you are dealing with here, Sabrina. You need a second opinion. You need someone who can interpret the clinical language for you. You need someone that can advocate for you like we do here at intensivecarehotline.com.

Once we looked at medical records or have spoken to doctors and nurses directly and understand all the details that are happening with your dad, then we can advocate for you and also handhold you through this process because, for example, if your dad can’t come off the ventilator with a tracheostomy, you probably wouldn’t even know that services like Intensive Care at Home are an option. Once again, families in intensive care don’t know what they don’t know.

Other things that need to be looked at in a situation like that are obviously ventilator settings, I hinted towards that earlier in relation to a tracheostomy. But let’s look at another scenario here, Sabrina, let’s just say your dad is getting close to coming off the ventilator. Now, you haven’t said anything here but, again, you need someone to verify the clinical issues that are happening right now.

So, many families come to us, intensive care teams tell them their loved one is brain dead. When we look at things, they’re just telling you that your loved one is brain dead just to push an agenda, just to push a narrative but no brain death testing has been done.

In your situation here, your dad probably can’t come off the ventilator. But have you actually verified that? Is he on too much sedation? Is he on too many opiates? Are they having a weaning plan? If they have a weaning plan, have they tried to implement? If they have implemented what stopped them from achieving that goal?

You need someone to give you a second opinion here as a matter of urgency before it’s too late because every day that your dad is on a ventilator without progressing forward, he will decondition very fast and then a recovery is more and more difficult.

Families in intensive care underestimate that they need help. They’re watching these videos and it’s good that you’re getting educated but you will need help. Those videos are not doing your family member justice in what they need.

This is giving you a lot of answers here what I’m doing. But in order to help your family member, your loved one in intensive care, we need to do some one-on-one work with you, which is why we have created a membership for families of critically ill patients in intensive care. 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 e-books and 21 videos that I have personally written and recorded. I’m sharing all of my decades worth of intensive care nursing experience with you, what’s happening behind the scenes, how you get results. Those e-books and videos will help you to make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment.

Furthermore, I also offer one-on-one consulting advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I handhold you through the process when you have a loved one in intensive care and get you two steps ahead of the intensive care team so, once, again that you start managing them, so they don’t start managing you.

I also talk to doctors and nurses directly and I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one 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. I also represent you in family meetings with intensive care teams. I have been in hundreds of those family meetings with intensive care teams.

We also offer medical record reviews in real time so that you can get a second opinion in real time. We also offer medical record reviews after intensive care if you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that, you get at intensivecarehotline.com. Call us on one of the numbers on the top of our website or 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, comment below what you want to see next, what questions and insights you have from this video, share the video with your friends and families.

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 of my YouTube channel, or if you are a subscriber to our 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.

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