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Quick Tip for Families in Intensive Care: Should My Dad in ICU Ventilated & Tracheostomy, Necrotizing Pneumonia and Pneumothorax Go to LTAC (Long-Term Acute Care)?

“Should my dad with chronic hypoxemic respiratory failure, tracheostomy, and history of necrotizing pneumonia with ongoing concerns for right-sided pneumothorax go to LTAC instead of staying in ICU?” That’s the question I’m going to answer today, and let’s look at it in much detail.

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

So currently, we’re working with a client and member who has their father in ICU, and has been having their father in ICU for quite some time now, with chronic hypoxemic respiratory failure, has a tracheostomy, is ventilated, and has a history of necrotizing pneumonia with ongoing right-sided pneumothorax.

Clearly, nobody should be going to LTAC (Long-Term Acute Care) on a ventilator with a tracheostomy. The reasons for that is that, when clients go from ICU or critical care into LTAC, and for those of you that don’t know what LTACs mean, LTAC stands for Long-Term Acute Care Hospitals.  This is basically only happening in the U.S.

Many patients in intensive care on a ventilator with the tracheostomy and the PEG (Percutaneous Endoscopic Gastrostomy) tube are being pushed out from ICU to LTAC. It’s a massive system failure, and the reason I’m saying that is, we have literally clients coming and families coming to us and asking us to help them get them out of LTAC . They’re literally begging us because the system is so bad. The LTACs are so bad.

Because LTACs, quite frankly, are a scam. As a matter of fact, I’ve made a video about it a while ago, “10 Reasons Why LTACs in the U.S. are a Scam,” and I encourage you to look at the online reviews of LTACs, any LTAC around the U.S., and they’re not good. People are dying in LTACs, it’s a complete system failure.

When it comes to necrotizing pneumonia, that needs specialized care, which patients in LTAC simply don’t get. With necrotizing pneumonia and also ongoing pneumothoraces, that needs specialized medical and nursing care, which simply is not available in LTACs.

Another thing that is happening with this particular member is that the hospital is trying to impose a DNR (do not resuscitate) order for this particular patient. We obviously have advised the family that they shouldn’t sign for a DNR or that it’s completely inappropriate. It’s actually up to the family and not to the hospital when the patient should be made DNR and there’s no wish from the family or the patient to have a DNR, but they’re also trying to create that narrative that with the DNR, it’s easier to send them to LTAC.

Like I said, many patients have died in LTAC because they don’t get the same level of care that they get in ICU and very few LTACs have the specialized skill to wean patients off ventilation and tracheostomy.

Also, sodium levels are below normal for this particular patient, and again, that needs to be corrected first. The best place to wean a patient off the ventilator and the tracheostomy is actually in ICU, not in LTAC.

Furthermore, this particular patient has not had any spontaneous breathing trials, because he’s hemodynamically too unstable, and secretions are copious at the moment, so all of that needs to improve before spontaneous breathing trials and ventilation weaning can even commence. Especially with necrotizing pneumonia, which sometimes can show up with a large abscess, empyema and necrotic cavities, it needs percutaneous drainage. It might need surgical debridement, or even a lobectomy or segmentectomy, which means that parts of the lungs need to be removed.

So, certainly, those are not cases for LTACs, because in those situations, patients can also rapidly clinically deteriorate. They can bleed massively and they can go into multi-organ failure. Like I said earlier, there’s a much higher risk for pneumothoraces.

For your dad to go to LTAC, he could only go if the LTAC was offering the same level of care and treatment that an ICU can, which they can’t.

So, how do you keep your dad in LTAC? Well, simply by advocating for him and following our advice, of course. But also, no ICU can discharge your dad without your dad’s consent, or if your dad can’t make decisions, without power of attorney consent, in your case, that’s you. Don’t let anyone force you. No one can force you to go to LTAC if there are clinical reasons not to go, and there are plenty of clinical reasons. So far, I know you’ve stood your ground anyway.

But I also want to share with our viewers here that, you have every reason to keep your family member in ICU instead of going to LTAC!

If they are ventilator and tracheostomy dependent, if there’s multiple complications. Multiple things that still need to be sorted because you won’t get that specialized nursing and medical treatment in an LTAC, simply not happening. Things will deteriorate very quickly. Don’t put your loved one in that situation.

We have helped so many families to keep their loved ones in ICU. Get the issue sorted there instead of going to LTAC. I have worked in critical care nursing for 25 years in three different countries, where I worked as a nurse unit 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 by looking at our testimonials section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done client interviews.

Because our advice is absolutely life changing, the advice and advocacy that we’re providing is so life changing that, like I said, we have saved many lives, and we’re improving the lives of our clients and our members instantly, so that they can make informed decisions, have peace of mind, control, power and influence, making sure their loved ones get 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. Once again, to improve their lives instantly, making sure they can make informed decisions, have peace of mind, control, power and influence, making sure their loved ones get the best care and treatment, always.

That’s exactly 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 can’t afford to get wrong. When I talk to doctors and nurses directly, 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 talk to doctors and nurses directly either one on one or I have you on the phone with them, or I’ll set you up with the right questions to ask.

I also represent you in family meetings with intensive care teams so that you can have clinical advocacy and representation on the 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 I have personally written and recorded. All of that, once again, will help you to improve your life instantly so that you 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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