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Quick Tip for Families in Intensive Care: My Mother’s Been in ICU for Two Weeks with Two Failed Extubations, Does She Need a Tracheostomy?

“I want to know if my mom needs a tracheostomy after two weeks in ICU on the ventilator with a breathing tube or if she can be extubated?” That’s a question we are having from one of our clients, and we’ll answer that question for our client today here in this video.

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

Our client has their mom in ICU for about two weeks and she’s unable to come off the ventilator. He wants to know if a tracheostomy and the PEG tube (Percutaneous Endoscopic Gastrostomy) is the best next step for his mom, and whether it’s in her best interest. So, let’s break this down for you.

So, at the moment, it is recommended that your mom undergoes a tracheostomy because she has been intubated for more than two weeks and she failed two trial extubations.

What’s a trial extubation? A trial extubation is that the breathing tube is taken out, but had to be reinserted, that’s then a reintubation. Unfortunately, those extubations failed. So, an endotracheal tube or a breathing tube should be in place for a maximum of two weeks. After that time frame, if your mom still needs respiratory support and the breathing tube, then a tracheostomy is advised.

Your mom’s failed extubations were due to airway swelling or airway edema, also known as stridor, and carbon dioxide retention. She’s not sedated, awake, alert oriented, and following commands, but she has respiratory weakness and hypoventilation, which is breathing that is too shallow or too slow to meet the needs of the body.  Tests were done to check for neurology related causes, such as brain CT (Computed Tomography), MRI (Magnetic Resonance Imaging), and EMG (electromyography), they were all negative. Autoimmune workup results from lumbar puncture are still pending. The stridor was resolved with prednisolone, and that is a steroid.

They can resume the ventilation weaning after the tracheostomy as tolerated and hopefully decannulate the tracheostomy thereafter. As for the impact of intubation to the vocal cords, it can cause inflammation, laryngeal edema, and in rare cases, vocal cord paralysis. However, in your mom’s case, she had a stridor after removal of the breathing tube, not during intubation. But prolonged intubation has an impact on the quality of her voice and ability to breathe. She may be very dependent on a ventilator, so more lung muscle strengthening is needed for her to be accustomed to breathing on her own.

In addition, her intake and output should be monitored. If she has too little output, the excess fluid in the body will accumulate in her lungs, making her breathing difficult. She needs repeat chest X-rays to check for pulmonary effusion or lung collapse or pulmonary edema.

It is also important to have arterial blood gases to check the oxygen and carbon dioxide levels in her blood. It is suggested to have pulmonology consult and input regarding hypercapnic respiratory failure. Hypercapnia means high CO2 or carbon dioxide. If carbon dioxide retention is not related to neuromuscular disorder or central nervous system depression, then it could be purely respiratory in nature. They can rule out chronic obstructive pulmonary disease, also known as COPD, or other respiratory issues.

As for a PEG tube, this can be postponed. Tracheostomy airway management is more important. As of now, if a tracheostomy and PEG are done, she can be easily transferred to an LTAC, as these are the requirements for an LTAC admission, and you should avoid that at all costs.

It has been reported that she has no swallowing issues. She denies dysphagia, so it’s better to have her swallowing tests and remove the nasogastric tube if there is no contraindication rather than placing a PEG tube. She’s awake, conscious and alert with no swallowing problems, so why not try to allow her to eat gradually through the mouth after the tracheostomy? This way she can taste the food and have her appetite back. The sooner she can get back to normal, the better.

I hope this information helps, and I hope that we helped you to make decisions that are actually in the best interest for your mom.

I have worked in critical care nursing for 25 years in three different countries, and 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 in our intensivecarehotline.com testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done client interviews, plenty of them.

Because our advice is absolutely life changing, that’s why that’s why we help our clients to improve their lives instantly, making sure they make informed decisions, have peace of mind, control, power, and influence so that they love ones get best care and treatment always. That’s one of the reasons why you can join a growing number of clients and members that we have helped over the many years, and we’ve helped families in intensive care all around the world.

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 can’t afford to get wrong. When I talk to doctors and nurses directly with you or on your behalf, 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.

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 only are exclusively accessible to our members. 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 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.

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