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Quick Tip for Families in Intensive Care: My Dad’s in ICU 11 Days Ventilated & Breathing Tube, The ICU is Refusing a Tracheostomy Help!

Today, I have an email from Colin who wants to know why your dad after 11 days in ICU on mechanical ventilation with the breathing tube can’t have a tracheostomy, stay tuned.

My name is Patrik Hutzel from intensivecarehotline.com and this is another quick tip for families in intensive care.

So, here’s the email from Colin who says,

“Hi Patrik,

My dad is currently in ICU and has been on mechanical ventilation with a breathing tube for 11 days now. His lungs aren’t strong enough to breathe on their own. He was rushed in from an anti-freeze poisoning. He is on hemodialysis  and has started to wake up and look around, respond, and move.

But because the ventilation is causing him so much pain and discomfort, he’s getting extremely agitated, making his blood pressure go up and down. So, they just re-sedate him, which makes his lungs stop working completely again.

But they are refusing to do a tracheostomy, which I think would be extremely beneficial, as he would be able to mouth words and not have to keep being sedated, as he’s already jaundice from liver damage. So, giving him all this sedation  and pain relief is killing him.

How do we go about trying to convince them to put a tracheostomy in? At this point, I really don’t think they care to try and help him recover.”

That’s a great question, Colin, and I’m very sorry to hear what you’re dealing with, because it sounds like your dad is in a critical but also improving state and the tracheostomy might help reduce sedation, improve comfort, and support long-term recovery.

But before we go down the tracheostomy route and talk about how we can advocate for it, let’s look at what else might need to happen before he’s having a tracheostomy.

One thing that you are not mentioning in your email, and one thing that they obviously don’t mention to you either is to get someone off the ventilator and the breathing tube full stop and avoid the tracheostomy full stop. You haven’t mentioned that in any way, shape, or form here.

Because he’s day 11 now, the time window for a tracheostomy is 10 to 14 days of mechanical ventilation and the breathing tube. If someone can’t be weaned off the ventilator and the breathing tube during that time window, then the best next step is a tracheostomy, hands down.

But it’s not quite day 14 yet. The question is, in those 3 days that he still has left, can he be weaned off the ventilator and the breathing tube?

Keep in mind the tracheostomy is a surgical procedure. Whilst it’s a straightforward procedure, in this day and age, it’s still, like any other surgical procedure, can come with complications such as surgical emphysema, excessive bleeding, potentially pneumothorax. There are risks that you have to take into consideration and are best avoided by not doing a tracheostomy.

One article and video that I strongly recommend you watch is I have made a video about, “How to wean a critically ill patient off the ventilator and the breathing tube?”, and I’ll put a link in the written version of this blog to that video and blog post because I encourage you to read through that or watch the video and find out and ask yourself, are they doing what I outlined in that video and blog post? Because if they are, then he might be close to coming off the ventilator.

Especially now that you’re saying he’s waking up and he looks around and responds and moves, and I totally understand that ventilation is causing him so much pain and discomfort, and he’s getting extremely agitated. But is that the only reason why his blood pressure goes up and down? Does he potentially have an infection? Have you asked that question? Does he potentially have an infection that makes his blood pressure go up and down?

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. They don’t know how to manage doctors and nurses in intensive care, and that might be what you’re up against right now.

Another important question to ask here is, what are his ventilator settings? Is he already breathing on minimal ventilation? Is he already breathing on pressure support or on CPAP (Continuous Positive Airway Pressure)? Because if he is, then you might be closer to coming off the ventilator than you think.

With his blood pressure going up and down, what are they giving him? Are they giving him fluids to manage your low blood pressure? Are they giving him inotropes, vasopressors to manage your low blood pressure? Are they giving him anti-hypertensives to manage a high blood pressure?

Whilst I understand that when they re-sedate him that his lungs might stop working completely again and they’re refusing a tracheostomy for now. They might do it for good reasons, they may not. This is why you need a second opinion because you don’t know what you don’t know. You don’t know even what questions to ask. Whilst he might already be jaundiced from liver damage and giving him sedation and pain relief is not helping his liver damage, they might still do it for good reasons.

So, what is important here? Important here is to ask what are his ventilator settings? What exactly is he on for sedation and opiates and pain relief? Get the facts. Intensive care is a science to a degree. You need to deal with facts, not just with general statements, is my dad ready to come off the ventilator? Yes or no? You have to look at everything, at all the details, at all the details.

But as a next step, first of all, you need to request access to the medical records. That’s Number 1. Number 2, you need to get me to talk to doctors and nurses directly there. Then, you will see what questions I’m asking, and you will see what questions I’m coming back with depending on what they say.

Also, is he getting physical therapy or physiotherapy? Are they doing breathing exercises, coughing exercises with him? Are they getting him out of bed? And yes, getting out of bed even with a breathing tube is possible. You’re absolutely right that continuous sedation and opiates might be worsening these conditions, once again, with liver damage and respiratory depression.

A tracheostomy could allow weaning off sedation, better communication. No question about it, hands down, that is what’s happening. But doing a tracheostomy for the wrong reasons, because he might just be a couple of days off might be the right way to go.

You should also be asking very succinct question, why are they refusing the tracheostomy? What are the risks they see? What is their plan for weaning him off the ventilator if his lungs aren’t strong enough? How will they prevent further harm from prolonged sedation and opiates?

If he can’t be weaned off the ventilator in the next couple of days, then they need to consider tracheostomy, but you need to get that second opinion. You can get that second opinion here from us here at Intensivecarehotline.com. Most of the time bringing in another specialist will shift their perspective, and they understand that you are having someone on your team that understands intensive care inside out.

It also doesn’t sound to me like they have mentioned that your dad won’t fully recover. They haven’t mentioned anything. I’m sure you would have mentioned it, but if their concern is that he won’t recover fully, then you should still mention that a tracheostomy will still improve his quality of life.

If they’re pushing towards end-of-life care, make it clear that that’s not an option for you and that your goal is full recovery, and your dad’s goal is probably full recovery. Again, you haven’t even mentioned anything.

That’s why you need to get advocacy and consulting in here, because it’s simply a knife’s edge, really, this situation. Because it’s a knife’s edge, you need to get the right advice. You need to get the right level of advocacy, because obviously, you’re reaching out because you can see that what you’re doing is not working and you don’t have all the insights here that I have.

I’ve worked in critical care nursing for 25 years in 3 different countries, where I worked as a nurse unit manager for over 5 years, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say we have saved many lives for our clients in intensive care with our consulting and advocacy. You can verify that on our testimonial section and you can verify it on our podcast section. Both you can access at intensivecarehotline.com if you click on the testimonial section and click on the podcast section for evidence for what I’m saying here that we have saved many lives for our clients in intensive care.

Now, also coming back to the email from Colin, another option here might be an extubation and putting him on BIPAP (Bilevel Positive Airway Pressure) and see whether that’ll help to avoid a tracheostomy. Again, you need to ask the right questions, and you need to know about treatment options, and you need to verify that they’re offering all the right treatment options, which I believe you haven’t been able to verify that even at this particular point in time because our advice here is absolutely life changing.

You can see that our advice is life changing, just by you listening to this video or reading the blog post. I’m sure I’ve uncovered things that you didn’t even know you need to pay attention to when you have a loved one critically ill in intensive care. So, our advice is absolutely life changing. You can join a growing number of members and clients at intensivecarehotline.com.

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 you and your families directly. 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 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 you have unanswered questions, if you need closure, or if you are suspecting medical negligence.

All of that, you get at intensivecarehotline.com, where 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 videos and 21 e-books that I’ve personally written and recorded. All of that 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 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, comment below what you want to see next, what questions and insights you have, share this video with your friends and families.

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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 now.