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 in intensive care.

If you’re watching this, chances are your loved one is about to have or is being prepared for a tracheostomy in intensive care and you’re wondering, “What does that really mean? What actually happens during the procedure and what should you expect afterwards?” Let’s break it down step by step so you can understand exactly what’s happening and make the best decisions for your loved one in intensive care.

So, here’s a question I have received from one of our clients, Ann, who says,

“Hi Patrik,

I hope you’re well.

My husband has decided he wants to do a tracheostomy. They are preparing him for the tracheostomy procedure as we speak. Normally, how does the tracheostomy procedure work? The ICU doctor states he will leave the nasogastric tube as it is.

Thank you for your prompt response.”

Thank you, Anne, for your question. A tracheostomy is a surgical procedure where a doctor creates a small opening at the front of the neck directly into the trachea, also known as the windpipe. Then, a tracheostomy tube is inserted through that opening. This tube becomes the new pathway for breathing. Instead of breathing through the mouth and nose, your loved one will now breathe through the tracheostomy tube.

The procedure can be done either at the bedside in ICU by usually ICU specialists or can be done in the operating theater by a general or an ENT surgeon, depending on the hospital set up and the patient’s condition. It usually takes around 20 to 40 minutes and during that time, the ICU team will sedate your loved one, sometimes even paralyze them briefly to make sure they’re comfortable and safe while the surgeon performs the procedure.

Once the tracheostomy tube is in place, the ventilator is connected directly to that tube, allowing for a much safer and more comfortable long-term ventilation option compared to the breathing tube through the mouth, also known as the endotracheal tube.

Now, regarding the nasogastric tube or NG tube, yes, it’s completely normal to leave it in after a tracheostomy. The nasogastric tube or NG tube provides feeding and medication directly to the stomach while your husband can’t eat or swallow normally. Sometimes later, if long term feeding is required, the nasogastric tube might be replaced with a PEG (Percutaneous Endoscopic Gastrostomy) tube, also known as a gastrostomy, which goes straight into the stomach through the abdominal wall.

After the tracheostomy is done, your husband will be monitored very closely in ICU for any complications like bleeding, air leaks, infections around the site, etc. The first 7 to 10 days are critical while the stoma, the hole in the windpipe, forms and heals.

From there, the focus shifts toward weaning off the ventilator, if possible. For some patients, that can actually happen on Day 1 of the tracheostomy, I’ve seen that. But for all this, it can take sometimes days, weeks, even months, sometimes it’s not possible to wean at all.

So, a tracheostomy, generally speaking, can make weaning easier because it reduces the discomfort of having a tube down the throat and allows for easier suctioning and airway management.

However, this is very important. You and your family need to understand the purpose and plan behind the tracheostomy. You must ask the ICU team, what is the goal of doing the tracheostomy? What’s the plan for ventilation weaning? How long do you expect your husband to stay on the ventilator? What’s the discharge plan after tracheostomy?

Because too often families are rushed into giving consent for a tracheostomy without understanding the short term, medium-term and long-term consequences like ending up in a long-term acute care facility (LTAC) if you are in the U.S. or staying in ICU long-term where care quality often drops and quality of life is basically non-existent.

So therefore, you need to be clear on short-term, medium-term, and long-term options. If your loved one, for example, can’t come off the ventilator and/or the tracheostomy for long periods of time, it’s best to look at options such as Intensive Care at Home, and you can find more information at intensivecareathome.com.

With Intensive Care at Home, we are bringing the ICU into your home, where we provide 24-hour critical care and ICU nursing care so that your loved one can have quality of life at home, ventilation weaning at home wherever appropriate instead of in ICU.

So, if you’re in this situation right now, don’t make this decision alone. Go to intensivecarehotline.com right now and call us on the numbers on the top of the website for a confidential one on one consultation that could lead to critical advocacy.

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.

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