Failed Ventilation Weaning in ICU? Why Intensive Care at Home is the Solution

Hello and welcome to another intensivecarehotline.com and intensivecareathome.com live stream, “Ask me anything: Life support in intensive care, ICU decisions, tracheostomy, and of course, Intensive Care at Home.”

Now, before I go into today’s topic, it looks like I’ve got some technical issues in terms of the camera. As you can see, my face is 90? upside down and I do not know how to change that. I’ve never had this problem before, but that should not stop me from creating value here today, and it won’t stop me from talking what I want to talk about today, which is pretty much ventilation weaning in ICU and what happens if it fails.

So, welcome to the show. Before I go into today’s topic, my name is Patrik Hutzel. I’m the founder and managing director of Intensive Care Hotline, as well as Intensive Care at Home, and you can find plenty of information about Intensive Care Hotline at the website intensivecarehotline.com, and also at intensivecareathome.com.

With Intensive Care Hotline, we are providing consulting and advocacy for families in intensive care all around the world. With Intensive Care at Home, we are obviously sending our critical care nurses into the home for predominantly long-term ventilation and tracheostomy, as adults and children. With Intensive Care at Home, we are replicating an ICU bed in the community, and we are improving the quality of life, and of course, quality of end of life for our clients and their families in intensive care.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities, as well as in all regional and rural areas. We are employing hundreds of years of critical care nursing experience in the community, and that is unmatched in this environment. No other provider can send more critical care nurses into the home, more experienced critical care nurses into the home than we can. We are also the only provider in Australia that is actually third-party accredited for Intensive Care at Home that actually has the intellectual property, that has the staff, that has the know-how, how to provide Intensive Care at Home, because that’s not something that just anyone can pull off. We have provided millions of hours of Intensive Care at Home nursing in people’s homes as a genuine and legitimate alternative to a long-term stay in intensive care.

So, what makes me qualified to host live shows here about ask me anything about intensive care, Intensive Care at Home, life support in intensive care, ICU decision-making, tracheostomies, Intensive Care at Home? Like I said, my name is Patrik Hutzel. I’m a critical care nurse by background. I have been a critical care nurse for over 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 all over the world since 2013, and I’ve been running Intensive Care at Home since 2012 in Australia.

Also, I had early exposure in my intensive care nursing career with Intensive Care at Home in Germany, where we were starting this service from scratch. We have helped so many families in intensive care, whether it’s with consulting and advocacy or whether it’s with Intensive Care at Home, that I can very confidently say that we have saved so many lives over the years. That is validated and documented in our testimonial section. It’s also documented in our intensivecarehotline.com podcast, where we’ve done client interviews that verify the work that we’ve done and we are doing.

Now, in today’s topic, I do want to talk about ventilation weaning. I want to talk about ventilation weaning in ICU. I also want to talk about ventilation weaning at home with Intensive Care at Home if ventilation weaning fails in hospitals. I want to mainly focus on ventilation and tracheostomy weaning. I’m not going to talk about ventilation and breathing tube weaning. I’m going to do that on another topic and on another YouTube live.

Now, also, if you want to talk to me directly, if you have any questions, please type them into the chat pad or connect with me live here on the StreamYard link. I’m just posting the StreamYard link in there right now. I also want to welcome our viewers on replay, because I know there’s always a lot of replays, but obviously this is your opportunity to ask questions here.

So, when ventilation and tracheostomy weaning fails in ICU, what’s next? I want to talk about home care options, but I also want to talk about what’s happening in ICU. To begin with, we help families of critically ill patients in intensive care to instantly improve their lives, make informed decisions, have peace of mind, control, power, and influence, making sure your loved one always gets best care and treatment, even if you’re not a doctor or a nurse in intensive care.

So, again, today’s live stream topic is a big one: “When ventilation and tracheostomy weaning fails in ICU, what’s next?” So, we’ll talk about what happens when your loved one can’t be weaned off the ventilator with a tracheostomy in ICU, why that might be happening, how you can take control, what the ICU team isn’t telling you, and most importantly, what your options are next, including taking your loved one home with Intensive Care at Home.

Make sure you stay tuned until the end. We will discuss why ventilator and tracheostomy weaning in ICU can fail, how proper weaning should be done, what the ICUs don’t tell you about alternatives, and how weaning can safely continue at home. If you have questions, type them into the chat pad or connect with me live here on the StreamYard link. Keep them on topic, please.

If I’m not covering the topic that you’re interested in today, send topics to me so that I know what you want to know. You can type them into the chat pad so I can prepare another YouTube live or you can email them to [email protected] and that always helps me to create better content and the content that you want.

So, why ventilation weaning with tracheostomy fails in ICU? Let’s start there. Also, if you like my videos, give the video a like, subscribe to my YouTube channel so you’re getting all the updates that I’m doing here. Share the video with anyone that you think will benefit, who has a loved one in ICU, and click the notification bell.

When a patient in ICU can’t be weaned off the ventilator, families are often told there’s nothing more we can do, and that’s simply not true. Here are the most common reasons why ventilation weaning might fail in ICU:

1. Sedation and pain management issues

Too much sedation like propofol, midazolam, or fentanyl is actually counterproductive. It actually diminishes and suppresses the natural breathing drive, so that’s obviously a concern. It’s counterintuitive and counterproductive to get someone on a breathing tube with a ventilator, and then sedate them, and pump them full of opiates, which will make it even more difficult to wean someone off the ventilator which leads to:

2. 2. ICU-acquired weakness

After weeks on a ventilator, patients lose muscle mass and strength, of course. They decondition and they lose the strength, especially in their respiratory muscles. That’s a concern.

3. Infection and pneumonia

Recurrent infections delay recovery and spontaneous breathing trials. One of the biggest risks for a ventilated patient in ICU is what we know of as VAP, which stands for ventilator-associated pneumonia. It’s been a big thing in ICU for decades.

Why are patients getting VAP? Well, because they’re exposed to a “dirty environment,” because ICUs are full of infectious people. Doctors and nurses, regardless of maintaining best practice for infection control, washing hands, hand sanitizers, wearing aprons, changing aprons, going from patient to patient, whilst that’s best practice, it’s still a much higher risk in ICU that infections are getting transmitted from patient to patient because of that. So, recurrent infections can delay recovery and spontaneous breathing trials.

4. Lack of individualized weaning plan

Many ICUs use a one-size-fits-all approach, rather than daily stepwise weaning tailored to the patient. So, there needs to be an individualized weaning plan to your loved one.

5. Lack of continuity of care

Nurses and doctors rotate and the patient’s progress often resets daily, not only do doctors and nurses rotate and the patient’s progress often resets daily, there’s another concern that whenever there’s long-term patients in ICU, and I can assure you that after having worked in ICU for such a long time, when you have Mr. Smith in Bed 8 and he’s been there for four months, people are getting tired of Mr. Smith. Nobody wants to look after Smith anymore. It’s boring, it’s not progressing, it’s not high acuity. Then, Mr. Smith gets looked after by the agency nurse and there’s a different agency nurse every day, so there’s lack of ownership. There’s lack of ownership.

6. ICU culture and pressure on beds

Sometimes the focus is on freeing up ICU beds, not long-term recovery. So, that’s why families in intensive care often get told, “Well, it’s in your loved one’s best interest to have end-of-life care. It’s in your loved one’s best interest to die, because otherwise they won’t have any quality of life.” Well, I debate that strongly here on this channel. I argue to talk to our clients with Intensive Care at Home. Talk to ICU survivors that may have been through hell, whether it was worth going through hell. As the old saying goes, “If you’re going through hell, keep going.”

ICU teams may then often say, “We can’t get your loved one off the ventilator,” and push for end-of-life. Or in the U.S., they might push for long-term care, nursing home transfers, which is futile. Long-term acute care, nursing homes, they’re not equipped to look after ventilated or tracheostomy clients, let alone wean them off the ventilator.

But the good news is, we’re talking about the truth here. Many patients can be weaned successfully in ICU with the right approach, and they can be weaned outside of ICU with Intensive Care at Home. But that requires the right environment, the right mindset, and the right expertise. That’s where Intensive Care at Home comes in.

But let’s just look at how proper weaning should be done in ICU to begin with. Proper weaning involves daily assessment for readiness, checking consciousness, oxygenation, and cough strength daily. Gradual reduction of support, slowly decreasing respiratory rate from your loved one, most likely in the beginning stages in a SIMV (Synchronized Intermittent Mandatory Ventilation) mode or in an ACV (Assist-Control Ventilation) mode.

Let’s just say they’re starting the rate of 18 breaths per minute, then you drop down the rate to 16. You’ll see whether your loved one can breathe up. Drop it down to 14, see whether your loved one can breathe up. Drop down to 12 and so forth. Making sure volumes are the same, making sure respiratory effort is not changing, making sure your loved one’s not getting exhausted too quickly, making sure arterial blood gases are the same, maintain steady. Making sure your loved one has a good day at night rhythm, sleeps at night, is awake at night, rests at night. And once the mandatory breathing rate is reduced, then you can move on to pressure support, CPAP ventilation. Then you can reduce the pressure support there, assuming breathing is fine, breathing is normal, tidal volumes are normal, arterial blood gases are normal.

Your loved one can breathe comfortably and can reduce the pressure support. Then move on to spontaneous breathing trials, go on a tracheostomy collar or a tracheostomy mask, and then eventually be liberated from the ventilator. Then, move towards tracheostomy decannulation ideally.

So, what else needs to happen? Physiotherapy and mobilization. Early mobilization strengthens the respiratory muscles and speeds up recovery. Now, goes as far as a good ICU will mobilize your patient on a breathing tube. Let me repeat that. A good ICU will mobilize your loved one on a breathing tube, even if they can only sit out in a tilt table, recliner bed, all possible. A good ICU will do that, assuming there are no contraindications, such as hemodynamic instability, such as fractures, that sort of thing. If they’re not doing it, they’re complacent. I’ve got no other things to say.

Next, speech and swallowing therapy to transition safely back to oral intake and communication, that is after ventilation has been weaned and your loved one is “only tracheostomy dependent.”

Number five, family involvement. Families who understand the weaning process can advocate for better care and continuity.

Number six, which is really important, and where I think Intensive Care at Home really trumps the ICU is continuity of care, regular teams that have a genuine interest in your loved one. There must be genuine interest, and that’s where I think Intensive Care at Home comes in. So, in ICU, like we talked about earlier, there’s a high staff turnover, there is no continuity of care. There’s disinterest and there’s no continuity of care.

So, Intensive Care at Home, part of what we do is we send you the staff that you want. We send you the staff that you know, like and trust.  We send you the staff that have a genuine interest in your loved one. I’ll give you another example of… maybe I need to put it a little bit more bluntly here, so that you really understand. When I worked in ICU and you’ve got long-term patients, Mr. Smith in Bed 8, who’s been there for 3, 4 or 6 months. I’ve heard of a patient this week that’s been in ICU for three years. Three years, can you imagine that? But ICU teams are getting bored by the long-term patients. They’re seen as a pain in the bum. Let’s just call it for what it is. I’ve worked in the environment long enough to not needing to sugarcoat anything here.

So, imagine going home with a regular team that you can help us select, people you know, like and trust that have a genuine interest. From an ICU perspective, the people that you grow tired of, we embrace them. We embrace them and their families. We want to deal with them. That’s what we want to do. That’s what we’re good at. We want to deal with Mr. Smith in Bed 8, that’s been there for 6 months, 12 months, that’s had enough of ICU. We can deal with their trauma. We can deal with the family’s trauma. We can deal with the family’s expectations, because most ICUs can’t deal with the family’s expectations anymore. They’ve grown weary of it. We haven’t. That’s what we uniquely specialize in. We have created a zone for our clients where they don’t feel judged for their desires, for their wishes to go home, and we don’t judge them for being traumatized.

If all of these elements are missing in ICU, weaning often fails and the ICU might prematurely conclude that your loved one can’t be weaned. And that if your loved one can’t be weaned, that automatically they won’t have any quality of life. What a whole lot of rubbish!

Ask our clients if they have quality of life, ask our clients if they want to leave, ask our clients if they’ve grown weary of living, and I can tell you they haven’t. Because unlike in a long-term ICU setting, our clients have community access every day. They go out every day. That’s a major shift, major difference. So, you also need to ask questions such as what is the weaning plan, if your loved one is in ICU.

What sedation is being used and why? And as a side note, no sedation should be used once your loved one has a tracheostomy. None. None whatsoever. It’s one of the main reasons the tracheostomy is being done in the first place. Same with opiates. Assuming there’s no major pain, opiates shouldn’t be used either. One of the main side effects of opiates and sedatives is respiratory depression. It’s counterintuitive. Next, what are the trial times of the ventilator on a daily basis? Has physiotherapy and physical therapy been started? What are the real or perceived barriers to weaning? And how can we overcome them?

Perceived barriers might be, “Well, we can’t do it.” That’s a perceived barrier. So, in any case, if you’re feeling that your answers are not getting answered, your questions are not getting answered from the ICU team, that’s where you need Intensive Care Hotline. That’s where we can help you at intensivecarehotline.com with consulting, with advocacy, making sure the intensive care team knows you’ve got people on your team that understand intensive care inside out. You can go to intensivecarehotline.com. You can book a free 15-minute consultation with me there.

After that, I do offer paid consulting and advocacy, but we are getting results for families in intensive care. Families in intensive care have no idea that you need to start managing intensive care teams so they don’t manage you. Not difficult, is it, to understand?  Most families have no idea that managing ICU teams is an option. They don’t believe that it’s an option, until they come to our website. So, you can manage intensive care teams with the right support, with the right insights.

Let’s look at what happens when weaning fails in ICU. What’s next? So, what happens when your loved one still can’t be weaned, despite all efforts? We can also help you. One of the questions I’ve asked many times here on this blog is, make sure they’re doing everything beyond the shadow of a doubt to help your loved one to come off the ventilator and the breathing tube. So, what happens if your loved one still can’t be weaned despite all efforts? This is the moment when ICUs often give you only two options: (1) Stay in ICU indefinitely, which is not sustainable or (2) move to a long-term care facility if you are in the U.S., where ventilator care is basically non-existent, and substandard at best, and recovery holds completely, often goes backwards, or (3) which is the best option, is obviously Intensive Care at Home. You can find more information at intensivecareathome.com. It’s the most underrated, but also the best one.

That’s what we will discuss next here, what are the options with Intensive Care at Home? So, with Intensive Care at Home, we provide 24/7 intensive care nursing in the comfort of your own home. We take patients home who are ventilated and tracheostomized, requiring ongoing weaning from the ventilator or who need long-term ventilation and can’t be weaned, want quality of life and family time. I guess, wanting quality of life and family time is inherent to all of the clients.

So, here is how that actually works. Well, (1) we replicate ICU-level care at home with a team of highly skilled critical care nurses, 24/7. It’s a genuine and legitimate alternative to a long-term stay in intensive care. (2) We use hospital-grade equipment, ventilator, suction, monitoring, humidifiers, all set up at home. (3) We provide individualized weaning plans with daily progress review and multidisciplinary collaboration, not any different to an ICU. We coordinate with hospitals, ICUs, and doctors to safely transfer your loved one home. Many, not all, clients have been successfully weaned off the ventilator at home after months or even years in ICU, simply because they finally received consistent one-on-one care with the right team that has a genuine interest in them, in our clients, and a peaceful environment for recovery.

Like I said, this week, I had two sort of epiphanies this week. Number one, I saw a client who’s been in ICU for three years. He’s ventilated with a tracheostomy. He wants a shot at weaning at home, and I’m very positive that we will be able to do that. Number two, I was at a conference on Friday, cardio-respiratory Physiotherapy Conference at the Gold Coast. Shout out to the Gold Coast Hospital and the physiotherapy team there who set up that one-day conference. It was a great conference.

And there, I spoke to an ICU physiotherapist there, and she told me, “Oh, we’ve got this Guillain–Barré patient in ICU for 6 months. Would be great if you can help to get this patient home.” And I said, “Yes, of course, we can.” Rather than spending $6,000 a day in ICU, why not spend half of that and go home, free up the ICU bed, and have quality of life for the patient and the family? If anyone in their right minds would want to say, “Oh, no, that’s not possible, that’s not doable, that’s whatever,” I’ll challenge them on any level.

Now, to manage expectations as well, not every patient can be weaned. I’ve also highlighted this many times on this channel here that patients with spinal injury, C1, C2 spinal injury, MND (motor neurone disease), most cerebral palsy clients also can’t be weaned because they are unfortunately degenerative and progressive conditions. And unfortunately, lifelong dependency on the ventilator is there, but we still improve their quality of life at home.

So, what are the advantages of Intensive Care at Home? I want to break this down into the benefits for everyone involved, basically for all stakeholders.

So, for families, it’s of course being at home, reunite with your loved one at home, improved emotional well-being, be part of the daily care and recovery, regain control and privacy. Also, for families who need to produce an income, you have the ability to go back to work, for example, instead of “living in ICU.”

So, for patients, better sleep, better nutrition, better emotional stability, reduced infection risk. Familiar environment is promoting healing. Family environment is promoting healing. Higher quality of life, a higher level of dignity.

But also, things like you have community access. You are in control of how you want your day to look like. You can select staff with us and you can help us creating the right teams. All of our clients have daily community access. They go down to the shopping centre with our nurses, they go to visit other family members, they go to the movies, they go wherever they want to go, really. We’ve been travelling with some clients. Your quality of life will be improved 10 times.

So, what are the advantages for hospitals and for ICU’s? Well, first and foremost, free up ICU beds, and that improves your bed flow and your ICU bed capacity. It reduces staff burnout, because if you’re an ICU professional watching this, you know as well as I do that your staff, doctors and nurses get tired of long-term patients. They perceive their families as being difficult. Let us deal with the “difficult families.” We love dealing with them, because that’s our area of expertise. We live and breathe it. Let us live and breathe it. For us, it’s not a burden. For us, it’s a privilege. I know you see it as a burden. You see those patients and their families as a burden. We see it as a privilege. Let it be our privilege.

So, you probably have a highest staff satisfaction as well, and you can free up staff, you can free up equipment, you can free up resources, and your emergency department will love you for that. Your operating theatres will love you for that. Your surgeons will love you for that, because there’s more capacity for them to do other necessary work, get other necessary work done, and get the patients that need care and treatment in hospitals to be looked after in a timely manner.

So, what’s in it for funding bodies, such as NDIS (National Disability Insurance Scheme), TAC (Transport Accident Commission), iCare, DVA (Department of Veteran Affairs) etc., private health funds? Well, first and foremost, you’re saving 50% compared to the cost of an ICU bed. The ICU bed, $5,000, $6,000 per bed day, that’s the most expensive bed in a hospital. It’s money well spent for the right patient at the right time, but not in the long-term.

Next, Intensive Care at Home is a proven safe model of care. We started Intensive Care at Home in 2012 in Australia. I’ve been working with the same model in Germany, in the pioneering days in Germany. So, we’ve built intellectual property for Intensive Care at Home over delivering by now millions of hours of Intensive Care at Home services. It’s a proven model and better patient satisfaction, and in some cases, better patient outcomes, including ventilation weaning.

But better patient outcomes also include their quality of life, which is another testimonial that ICUs need to stop talking about perceived quality of life, because they don’t really know what that looks like outside of intensive care, whereas we do. We do know what that looks like. If you don’t, then I encourage you to start talking to us and look at some of our testimonials, look at some of our case studies, patient stories.

I really welcome your questions about this topic. Type them into the chat pad or connect with me live here on the StreamYard link. You can talk to me. Opening up the floor here for any questions.

In the absence of any questions for now, what needs to happen at home? Well, I’ll tell you what needs to happen at home to wean someone off the ventilator. Well, got to get the equipment, ventilators, suction machines, monitors, nebulizers, hospital bed, wheelchairs, hoists or lifting machines. You got to have doctor oversight, which means you got to have medical cover, got to have CCRN nursing team, of course. You might need a CO? monitor. But again, we can organise all of that or transdermal CO? monitor. Potentially, an i-STAT machine for monitoring ABGs at home, arterial blood gases at home. But I’ll tell you what you need most of all, which is easy to be quantified. You need the right mindset, the right thinking, a can-do attitude, and a cohesive team that can make that happen. We think we have all of that.

The staff that we’re employing are fantastic. They are committed to our cause, and they know what that long-term patient in ICU looks like, and they know what that long-term patient in ICU needs. They don’t need another weaning trial in a hospital, if it’s failed. They need a proper weaning trial at home, in a nice family-friendly, patient-centered, holistic environment. It’s common sense. You could argue that common sense is no longer all that common.

So, we really can’t wait to get more clients that can go home for weaning. I’m sure, you watching this, you are dying to get home, if you have a loved one in ICU with long-term ventilation and tracheostomy. I know you’re dying to go home, and don’t wait any longer. Contact us at intensivecareathome.com. Or if you need to get to the point where you need to get to the point of tracheostomy or where you even need to get to the point of weaning, because there’s other medical issues happening, delaying that, then I encourage you to reach out to us at intensivecarehotline.com, so we can hand-hold you through this once-in-a-lifetime situation that you really can’t afford to get wrong because we can help you fast.

Another thing that we provide is we’re providing NDIS support coordination and NDIS specialist support coordination. We are also providing TAC and WorkSafe case management in Victoria, or TAC and WorkSafe Victoria clients can be outside of Victoria as well. We’ll put you in charge so that you can regain control and make informed decisions.

Other things that need to happen and fall into place in a home care setting are allied health. We need to work with physiotherapists, with OTs (occupational therapists), with speech therapists, dietitians. That’s all part of the package to go home. We have a network of such people. It is all about the people. I can’t stress that enough that it’s all about the people. The right people for the right client, for the right cause, with the right goals. That’s what we are here to provide for you and for your families.

Now, I know some of you might be concerned about the funding. They might say, “Oh, is there going to be enough funding? Who’s going to pay for it?” I do not want you to worry about that. I really don’t, and I’ll tell you why. We as an organisation and our clients wouldn’t exist if the funding wasn’t there. We can help you with that step-by-step, who to talk to, what to do, who are the right advocates that need to be involved to get you what you want. It’s important that you don’t lose sight of getting what you want, because ICU might’ve told you, you can’t get what you want. Forget about that.

Also, you might hear things in ICU where the ICU team might be saying to you, “Oh, yeah, your loved one will never breathe again.” Or they might be saying, “Oh, now your loved one has a tracheostomy and a ventilator, they can’t wean off in ICU. Now they’re stuck in this forever.” Now, I’m not giving you a guarantee here that your loved one can wean off the ventilator. What I am telling you is that if you are going home, the chance is still there to wean off the ventilator and the quality of life for your family member will improve big time. There’s a lot of truths that ICU won’t tell you, and you need to be aware of that.

So, we can provide you with all the resources, all the support, all the advocacy, because that is really so important. Now, what questions do you have? Type them into the chat pad or connect with me live here on the StreamYard link. If there are no questions, and I do want to wrap up in a minute and we will go from there.

Now, again, with intensivecarehotline.com, we’re providing consulting and advocacy for families in intensive care all around the world. We have saved many lives for our clients and families in intensive care and you can verify that on our testimonial section at intensivecarehotline.com, and you can verify it on our intensivecarehotline.com podcast, where I’ve done many client interviews as well.

With Intensive Care at Home, we are providing a legitimate and genuine alternative to a long-term stay in intensive care, predominantly for long-term ventilated adults and children with tracheostomies, BIPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure) ventilation at home without tracheostomy, tracheostomy care without ventilation, and also Home TPN (Total Parenteral Nutrition), home IV potassium, home IV magnesium, home IV antibiotic infusions, cough assist management at home, central line, PICC (Peripherally Inserted Central Catheter)  line, Hickman’s line, port management at home, nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) tube and PEJ (Percutaneous Endoscopic Jejunostomy) management, ventilation weaning, palliative care at home as well.

We provide NDIS Level 2 and Level three, especially support coordination, TAC and WorkSafe case management. Like I said, we are the only provider in Australia that is third-party accredited for Intensive Care at Home. There’s no other provider that has achieved that high level of accreditation and has built the intellectual property that we have built here at Intensive Care at Home.

That’s something we’re extremely proud, of course. We have a high-performing team and people that are extremely committed to our cause. Like I said, the biggest difference here is that we provide regular teams, the people you know, like and trust, that can build a relationship with you, that you can build a relationship with, that have the emotional intelligence to work in your home. Most of all, we have the right mindset. It’s all a mindset thing.

So, I do want to wrap this up. I also want to reiterate right now we are with Intensive Care at Home. We are operating all around Australia in all major capital cities, in all regional and rural areas. We are location independent, because we can find staff pretty much anywhere.

I also want to talk about our U.S. audience here. If you want Intensive Care at Home in the U.S., you need to let us know. We can help you privately. So, please reach out to us as well if you are in the U.S. or in the U.K., same in the UK.

Now, also, if you like the video, give it a thumbs up. Subscribe to my YouTube channel. Share this video with anyone who can benefit from the information, if you have a loved one in intensive care and so forth. Subscribe and click the notification bell. Share this message far and wide with anyone that has a loved one in intensive care.

Now, I wish you and your families only the very best, and keep an eye on what’s happening during the week here. There will be other updates coming about topics that you are interested in. If you want a specific topic to be covered, whether it’s on a short video or on a YouTube live here, let me know so that I can keep creating the content that you want. We’ll wrap this up here today.

Have a great rest of the weekend and a good week ahead. Stay safe. Take care for now.

Now, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24 hours a day. We are providing the following:

• Home care services for ventilated adults & children with tracheostomies with critical care nurses 24 hours a day
• Genuine alternative to a long-term stay in intensive care or at long-term acute care
• Tracheostomy care for clients without ventilation
• Home care services for patients on non-invasive ventilation such as Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure)
• Home TPN (Total Parenteral Nutrition), which is also known as IV nutrition
• Home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics
• Providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home.
• Providing nasogastric tube and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home
• Use cough assist machines for our clients for airway clearance at home
• Palliative care services at home
• Ventilator weaning at home

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully as part of the Western Sydney Local Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home, instead of them going to an emergency department.

That also means, we’re also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs between $5,000 to $6,000 per bed day. Our services costs between $2,500 to $3,000 per bed day, and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. Most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders. Of course, quality of life is much improved surrounded by families and by a team of dedicated intensive care nurses in the home care setting instead of in an intensive care unit.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We work with NDIS (National Disability Insurance Scheme) clients all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, Department of Veteran Affairs (DVA) all around Australia. Our clients and we, as a service provider, have also received funding through public hospitals, private health funds, as well as Departments of Health.

We are having policies and procedures for Intensive Care at Home nursing and we’ve built all the intellectual property for Intensive Care at Home since 2012. No other provider in Australia has created more intellectual property when it comes to Intensive Care at Home nursing than we have. This puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2025 employs a higher skill level in the community than we do, which enables us to look after the highest acuity adults and children in the community in Australia safely.

If you’re at home already and you’re watching this, or you’re stuck in an ICU long-term, or if you’re going to the hospital and ED all the time, and you realize that you don’t have the right level of support at home, or if you are stuck in an ICU, I’ll give you a real-world example today, how we can help you.

One of our first clients when we first got started in 2012, was a client who was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers are not equipped to look after a client at home on a ventilator with a tracheostomy. That is dangerous and it’s simply negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy is like flying the airplane with a cabin crew instead of the pilot. Because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies 24/7, or even at high risk of dying if they don’t have a team of dedicated critical care nurses looking after them 24/7 at home. This is actually evidence-based and is documented in our Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com.

Think about it, in an intensive care unit in a hospital, you wouldn’t have support workers looking after your critically ill loved one or after any critically ill patient on a ventilator with a tracheostomy. So, why would anyone in their right mind do that in the home care environment in the community?

So, this client at the time found out about us eventually, and the ICU that he was basically living in also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with this particular client, we sent him critical care nurses, 24 hours a day. He never ever went back into ICU ever again, as long as we were working with this client.

We can do the same for you if you’re not safe at home and help you with keeping you at home predictably. Otherwise, we would not be in business. Again, the same is applicable for those stuck in an ICU, similar to this case study that I’ve just given you, or if you’re going back to ED all the time, please reach out to us. We can help you with taking you through the right steps, including how to get funding with different funding bodies.

This is also why we are providing NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS support coordinators, and I’ll put a link to an interview with Amanda in the written version of this blog. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

If you’re an NDIS support coordinator or a case manager from another organization watching this, and you’re looking for nursing care for your participants, please reach out to us as well. If you need more evidence for nursing care, we are also writing NDIS nursing assessments with legal nurse critical care consulting nurses.

If you are a critical care nurse and you’re looking for a career change and you want to join a very progressive, dynamic, and high performing team of critical care nurses in the community, we’re employing hundreds of years of critical care nursing experience combined. You can join this high performing team if you are a critical care nurse.

If you are looking for a career change as a critical care nurse, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I do have a disclaimer though, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients also do want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular staff. So, if you’re looking for agency work, where you can come and go, this will not be the right fit for you. We are looking for consistency and our clients are looking for consistency. So please, only apply with us if you can give us regular and consistent availabilities for shifts, and you’re really keen on building solid relationships with us and with our clients.

If you’re an intensive care specialist or an ED specialist, we also want to hear from you. We’re currently expanding our medical team as well. We can also help you eliminate your bed blocks in your ICU and in your ED for your long-term patients, or for your regularly readmitting patients with our critical care nursing team at home. We’re here to help you take the pressure off your ICU and ED beds. In most cases, you won’t even pay for it. Even if you do pay for it, it is so much more cost-effective than what you’re paying for in ICU and ED, and you get the same level of care.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, or for home TPN, please reach out to us as well. We can help you eliminate your bed blocks very fast.

If you’re in the U.S. and in the U.K. and you’re watching this, and you need help, we want to hear from you as well. We can help you there privately with one-on-one consulting and with hiring nurses privately.

Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected].

If you like my videos, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and intensive care. Click the like button, click the notification bell, share this video with your friends and families, and comment below what you want to see next or what questions and insights you have from this video.

Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.