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Quick Tip for Families in Intensive Care: Does My Ventilated Dad in ICU with Parkinson’s & Stroke Need a Tracheostomy & PEG (Percutaneous Endoscopic Gastrostomy) Tube? Can It Be Avoided?
“Should my dad with Parkinson’s disease in ICU have a tracheostomy and the PEG (Percutaneous Endoscopic Gastrostomy) tube? He’s currently intubated with a breathing tube.” That’s the question we’re going to answer today.
My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.
This is actually a question from one of our members that we’re currently working with and we’re reviewing the medical records to advise our member so that they can make an informed decision, have peace of mind, control, power and influence, making sure her dad gets best care and treatment always.
So, let’s look at the evaluation of the medical records.
Your dad, who has advanced Parkinson’s disease, hypertension, which is high blood pressure, high cholesterol, chronic urinary retention, and a history of pulmonary embolism, was admitted on 6/18/25 after a mechanical fall that caused a subdural hematoma (which is a bleeding in the brain). He underwent craniotomy on 6/19 for evacuation of the bleed. Since then, he has shown signs of neurologic improvement, he is awake, intermittently following commands, tracking with his eyes, and has a Glasgow Coma Scale score of 10. Glasgow coma scale is a tool to assess your dad’s consciousness. You can read through the article below about GCS.
How to Assess Glasgow Coma Scale (GCS) in Adults and Children?
So, we continue in the medical record review.
Your dad was extubated on 6/20, so just one day after the craniotomy, but had to be reintubated, which means the reinsertion of the breathing tube, on 6/21 due to an inability to manage secretions, not because of respiratory failure. He remains on minimal ventilator settings (FiO2 30%, PEEP 5) with vital signs stable, his recent arterial blood gas on 6/25/25 with good oxygenation. Arterial blood gas (link below) test is to check how well his lungs are working. On exam, his lungs are clear, breath sounds are equal, no signs of pneumonia, which suggests that his lungs are functioning well and that he may be a candidate for another extubation trial, with better secretion management. Extubation means the removal of the breathing tube.
What is an Arterial Blood Gas Test (ABG)?
https://intensivecarehotline.com/questions/what-is-an-arterial-blood-gas-test-abg/
According to standard clinical protocols, a tracheostomy is typically only considered after 10 – 14 days of failed ventilator weaning or repeated failed extubation attempts. In your dad’s case, he is alert, showing neurologic improvement, and remains on minimal ventilator settings, which suggests he still has a good chance of coming off the breathing tube and the ventilator with the right support. Therefore, a tracheostomy is not necessary at this point in time.
When we looked at the medical records, it was found that the primary barrier to extubation has been oropharyngeal dysfunction and difficulty managing secretions, likely related to advanced Parkinson’s disease. However, there is no evidence of new neurologic injury affecting the swallow reflex directly. Your dad’s care team is suggesting a tracheostomy and PEG to prepare for LTAC transfer, but we strongly advise against this. His condition may worsen there. He should remain in the ICU with the respiratory, neuro, intensivist and swallow team support, as he still has a good chance of being safely extubated without needing a trach.
So, what is really important in situations like that is that you read between the lines. What do I mean by that? Most ICUs in the U.S. and this is one of our members in the United States.
In the U.S. in particular, most ICUs want to do a tracheostomy to send patients to LTAC. LTAC stands for long-term acute care hospitals or long-term acute care facility, and they are not even the better version of a nursing home. Therefore, we strongly, strongly reject patients going to a LTAC because they are disaster areas.
Case in point, just look up the LTACs if you’re in the U.S. Just look up the LTACs that are in your area and look up their reviews online and let me know what you think, comment below this video. You will see why I’m saying they are not even the better version of a nursing home, they claim, they can wean patients off the ventilator, they have high success rates; nothing could be further from the truth. Most ICUs are pretty good at weaning patients off the ventilator because they have the skills, the expertise, and often the staffing levels.
Let’s continue in the medical record review.
As for the feeding tube, he’s currently getting nutrition through a soft tube that goes into his nose (it’s a Dobhoff tube, it’s like a nasogastric tube) and is tolerating the feeds and the tube well. He has not had any signs of vomiting or aspiration. A PEG tube (which is surgically placed in the stomach) is generally not needed unless someone cannot eat or tolerate feeding long-term. Since he’s receiving adequate nutrition now, a PEG should be avoided at this point in time.
In summary, based on his current condition, alertness, stable breathing, and ability to receive nutrition, your dad does not need a tracheostomy or a PEG tube.
So, that’s how we go about things and advising patients and families correctly with the patient’s best interests in mind. The hospitals sometimes, not all the time, don’t have the patient’s best interest in mind. What they do have in mind is their bed numbers, their staffing numbers. If they don’t have enough beds and don’t have enough staff, they would want to send patients out to LTAC as quickly as possible. The only way to do that is by doing a tracheostomy and sending patients to LTAC.
Also, the other thing that is important to note here. If you give consent to a tracheostomy but not a PEG, most LTACs will not take the patient. So, by you simply putting a stop to a PEG tube and just continue feeding with the nasogastric tube, which is perfectly fine, you’re already putting a stop to patients going to LTAC. That should be a concern for you anyway because if an LTAC can’t look after nasogastric tube, that should tell you everything you need to know. They can’t look after nasogastric tube, how can they possibly look after ventilator and a tracheostomy to tell you everything you need to know?
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 for our clients in intensive care. You can verify that on our intensivecarehotline.com testimonial section and also on our intensivecarehotline.com podcast section where we have done client interviews.
Because our advice is absolutely life changing, it is absolutely life changing. That’s why you can join a growing number of members and clients that we’re helping in intensive care. We’re improving their lives instantly, making sure families in intensive care can make informed decisions, have peace of mind, control, power and influence, making sure their loved ones get best care and treatment always.
Because 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 is exactly what you’re up against.
That’s why I do one on one consulting and advocacy over the phone, Zoom, Skype, 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 doctors and nurses directly, which I do as well, you would see the dynamics change in your favor very quickly because you have someone on your team that understands intensive care inside out.
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 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. 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 that only our members have access to.
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.
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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.
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