Good morning, good afternoon, good evening, wherever you are.

Welcome to another intensivecarehotline.com and intensivecareathome.com livestream. Today, we will be covering tracheostomy versus breathing tube complete family decision guide. We’ll be going for about an hour to answer your questions about this very important topic. We get a lot of questions around this topic when families have loved ones in intensive care with a breathing tube.

If they can’t be weaned off the ventilator, should they go for a tracheostomy or not? So have your questions ready or if you are watching this on replay, type them into the chat pad so I can follow up with another video. Go to intensivecarehotline.com for ICU support if you have a loved one in intensive care and go to intensivecareathome.com if you’re in a situation where your loved one is stuck in ICU and needs long-term ICU and look at long-term ventilation with or without a tracheostomy.

So today, I believe will be one of the most important 60 minutes for families facing one of the hardest decisions in ICU. Tracheostomies versus keeping a breathing tube. Once again, my name is Patrik Hutzel from intensivecarehotline.com and intensivecareathome.com. And over the next hour or so, I’m going to share with you what doctors often don’t have time to explain, the real difference between a tracheostomy and an endotracheal breathing tube when each option makes sense. Most importantly, the life-changing options for coming home with a tracheostomy that most families never hear about if tracheostomy is the only sensible option.

Now, before I dive into today’s topic, what makes me qualified to talk about tracheostomy versus breathing tube or breathing tube versus tracheostomy in ICU? My name is Patrik Hutzel. I am a critical care nurse by background having worked in critical care nursing for over 25 years in three different countries.

I’ve worked as a nurse manager for over five years in intensive care. I’ve been consulting and advocating for families in intensive care all around the world with my team here at intensivecarehotline.com. And I’m also the founder and managing director of intensivecareathome.com with Intensive Care at Home, providing home care services for long-term ventilated adults and children with tracheostomies, home care for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure) without tracheostomy. Tracheostomy care at home without ventilation, cough assist management ventilation, weaning management at home, home TPN, home IV potassium, home IV magnesium, home IV fluid, home IV antibiotic infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s and port management at home, PEG (Percutaneous Endoscopic Gastrostomy) tube tube management at home, nasogastric tube, nasojejunostomy tube management at home, SPC (suprapubic catheter) and IDC (indwelling catheter) management at home, as well as palliative care at home.

We’re operating all around Australia with Intensive Care at Home, and we’re the only Intensive Care at Home nursing service in 2026 that has actually achieved third-party accreditation for home ventilation in Intensive Care at Home. No other service provider has achieved this high level of accreditation, ever, in Australia. We are employing hundreds of years of critical care nursing experience combined, and we’re operating all around the country.

We’re also providing Level 2 and Level 3 NDIS support coordination as well as TAC (Transport Accident Commission) and WorkSafe case management. So here’s what we’re covering in the next 60 minutes. Let’s look at the hospital decision, ICU decision. What’s the real difference between tracheostomy and a breathing tube? Why doctors recommend tracheostomy after 10 to 14 days? The risks nobody talks about with long-term breathing tubes, recovery timelines and what to expect, questions you must ask your ICU team, and that’s what we cover in the roughly first 30 minutes of this presentation.

And the second 30 minutes, we look at the home care revolution with Intensive Care at Home in case your loved one ends up with a tracheostomy long-term or ends up with ventilation and tracheostomy long-term, ends up on a ventilator with BIPAP or CPAP and how to then leave intensive care safely and use Intensive Care at Home as a safe option to keep your loved one out of ICU predictably and permanently because home ventilation with Intensive Care at Home changes everything for tracheostomy patients, evidence-based guidelines for safe home mechanical ventilation with Intensive Care at Home.

Also, evidence-based and accreditation for Intensive Care at Home, community access and quality of life at home versus ICU, real stories of adults and children thriving at home with tracheostomies, how to transition from ICU to home care successfully. And I’ll be answering your questions throughout, so keep them coming, type them into the chat pad.

Before we dive in, another quick comment about intensivecarehotline.com. We help families navigate the ICU when the loved ones are critically ill. We provide expert guidance, second opinions and advocacy when you need it the most. And with Intensive Care at Home, once again, we provide evidence-based and accredited 24/7 intensive care level nursing care at home for adults and children with complex needs, mainly on ventilation with or without tracheostomies. And we have helped thousands of families with our consulting and advocacy.

And we have helped hundreds of families to bring their loved ones’ home from ICU. When hospitals says it wasn’t possible and all this sort of nonsense. And if you haven’t already, hit the like button, hit the subscribe button right now and turn on notifications so you don’t miss out on any, what I believe, are life-saving updates here. I go live regularly with ICU education that has saved and continues to save lives.

What Is a Breathing Tube Versus a Tracheostomy? 

First, let’s get crystal clear on what we’re actually talking about because the terminology confuses a lot of families. An endotracheal tube or an ET (endotracheal) tube is a standard breathing tube, goes in through the mouth or the nose. 95% of the time it goes through the mouth. In some patients, it goes through the nose, mainly pediatrics goes through the nose.

It passes through your vocal cords into your windpipe. It connects to a ventilator for breathing support. It’s meant to be short-term. We’re talking days to maybe a couple of weeks’ maximum, requires heavy sedation and opiates because it’s extremely uncomfortable. You cannot talk, eat, or drink with an endotracheal tube or a breathing tube. Must be secured with tape to your face. It’s often tied around the face. It’s just not a very nice and a very good thing.

There are some ET tube holders these days, making it a little bit more comfortable, making it more safe, but it’s by no means, ideal. Compare that to a tracheostomy, a surgical opening created in the front of the neck. A tube goes directly into your windpipe bypassing the mouth and vocal cords. Can also connect to a ventilator if needed. Designed for longer-term use, we’re talking about weeks, months, or even permanently, depending on the situation.

Much more comfortable. Most patients need little to no sedation or opiates. Many patients can talk with special speaking valve, but only if they can have time off the ventilator. They’re still unable to talk if they’re attached to a ventilator. Some patients can eat and drink safely. It is way more secure and lower infection risk than prolonged endotracheal or breathing tube. Drop a comment, if this is making sense so far. This is the foundation today we’re building on.

The other thing that I want to point out before I move along is no matter where you’re at with a breathing tube with your family member in ICU, here’s the most important thing. The questions you need to ask all need to be targeted, what is the ICU team doing to try and move your loved one off the ventilator and the breathing tube? Beyond the shadow of a doubt, let me repeat that.

Your test questions need to be targeted towards what is the ICU team doing to get your loved one extubated and have the breathing tube removed beyond the shadow of a doubt. If they can’t answer those questions, you’re probably not dealing with the right ICU team, or I can phrase this question differently, is the ICU team doing everything beyond the shadow of a doubt to avoid the tracheostomy? As much as tracheostomies have their time and their place, the first job of the ICU team in ICU when your loved one is coming in, needs a breathing tube, needs sedation, needs an induced coma, is to reverse it all.

That is what you should be focusing on, especially in the early stages of your loved one’s ICU admission. As much as we will be talking about tracheostomy, this is the foundation that I want to set here. As much as we, with Intensive Care at Home, we’re dealing with tracheostomies all day long and have been for a long time, still avoiding it is the much better place. So now that’s out of the way, let’s see what happens in most ICUs.

When someone needs a breathing tube and ventilator, doctors initially place an endotracheal tube or breathing tube, expecting the patient will recover quickly and come off the ventilator within a few days. That is the goal that should be the aim. That should be your primary focus in the first few days. But if day seven passes, then day 10 and then approaching day 14 and your loved ones still can’t breathe on their own, the medical team will start talking about tracheostomy and here’s why:

Vocal cord damage and scarring. Tracheal stenosis narrowing of the windpipe that may need surgery later. Sinusitis and pneumonia rates increase, also because of ventilator associated pneumonia (VAP) risk. Pressure sores in the mouth and throat. Difficulty weaning because the tube itself increases work of breathing. And once again, the sedatives and the opiates make breathing or ongoing sedatives and opiates make weaning even more difficult because there is a need for continuous deep sedation creating its own complications, including respiratory depression.

That’s the very thing that needs to be avoided. You can’t wean someone off a ventilator that has respiratory depression because of the medications they’re getting.

Let’s also talk about the benefits of tracheostomy when ventilation will be prolonged. Dramatically more comfortable patients wake up, become alert, easier to wean from the ventilator because the tube is shorter and wider. Lower infection risk can start rehabilitation physical therapy, even walking with ventilation support, enables communication with speaking valves.

Potential for eating and drinking, opens the door to home care and will talk extensively about this in the second part of today’s presentation. According to evidence-based guidelines, and I’ll show you the research later, tracheostomy should be considered when mechanical ventilation is expected to continue beyond 14 days. Some studies suggest even earlier, around seven to 10 days for certain patients. Comment below, has your medical team discussed the 14-day timeline with you and your families?

And once again, if you’re watching this here right now, and maybe you’re watching it on replay, go back to your ICU team and ask them what are they doing beyond the shadow of a doubt to get your loved one off that ventilator and the breathing tube and have your loved one extubated. That is the most important question you need to ask. I’ve made videos about this. How to wean a critically ill patient off the breathing tube and the ventilator?

I encourage you to check that out on our website at intensivecarehotline.com. It’s probably one of the most important videos, so you can watch if you are in that situation. Because it should be ideally short, sharp extubation and then, get on with the recovery, move on to a hospital ward, move on to a hospital floor. This is a critical injunction here, breathing tube versus tracheostomy, absolutely critical injunction. But also, let’s address common myths and fears that I hear from families in intensive care every day.

Common Myths and Fears 

For example, Myth number one: Tracheostomy means giving up. Reality: Nothing could be further from the truth. It’s actually often a turning point towards recovery. Patients become more alert, start rehab, and many eventually have the tracheostomy removed.

Myth number two: Once you have a tracheostomy, you’ll never get off the ventilator. The reality is that tracheostomy actually makes ventilation weaning much easier and more successful in most cases.

Myth number three: You can’t live a normal life with a tracheostomy. Again, the reality is this is what we’re going to spend the second half of this session proving wrong. Thousands of people live full active lives with tracheostomies going to school, work, traveling, and yes, living at home, not in an ICU.

Myth number four: The procedure is too risky. The reality is that tracheostomy is a routine procedure with reasonably low complication rates, especially compared to the risk of prolonged intubation.

Are any of these fears or myths resonating with you? Please leave a comment if you wish. Let’s now look at the ICU perspective or the hospital perspective when a tracheostomy is recommended. Let me give you the specific clinical scenarios where tracheostomies might be the right choice.

Number one: prolonged ventilator dependence, failed multiple attempts to remove the breathing tube. Underlying condition requires weeks of breathing support.

Neuromuscular diseases like motor neuron disease, Guillain-Barré, cerebral palsy, Duchenne, muscular dystrophy, Rett Syndrome, the list goes on, COPD (Chronic Obstructive Pulmonary Disease), asthma, pulmonary fibrosis, even cardiac diseases. The list is really very long. I’ve seen in my time in ICU and also obviously with Intensive Care at Home, I’ve seen many other conditions as well, acquired brain injury, traumatic brain injury. The list goes on. C1, C2 spinal injuries, C3, spinal injuries, and so forth. Severe lung injury requiring extended recovery time.

Next, number two: Airway protection issues. Stroke or brain injury affecting swallowing and airway reflexes, excessive secretions that need regular suctioning, risk of aspiration.

Number three: Upper airway obstruction, tumors, swelling or structural problems, facial or neck trauma, anticipated long recovery, multiple organ failure, severe COVID-19 or pneumonia, major surgery complications, burns or trauma.

The key question your medical team should be asking, what’s the realistic timeline for recovery and will it exceed 14 days of ventilation? Once again, go to intensivecarehotline.com if you need help getting clear answers from your medical team or want a second opinion on your loved one’s situation.

The Tracheostomy Procedure and What to Expect 

Let’s now also look at the tracheostomy procedure and what to expect. Families want to know exactly what happens. Let me walk you through it.

Before the procedure: It can be done at the bedside in ICU or in the operating room. If it’s done at the bedside in ICU, it’s called a percutaneous tracheostomy. If it’s done in theaters, in the operating room, it’s called a surgical tracheostomy. Patient receives sedation and pain medication, sometimes paralyzing agents, it takes about 20 to 30 minutes. Typically, consent obviously needs to be signed by family, designated decision maker, or sometimes by the patient themselves.

During the procedure: A small incision in the front of the neck, opening created in the trachea, also known as the windpipe. Tracheostomy tube is inserted, ET tube, endotracheal tube or breathing tube is removed. The tracheostomy tube is secured with ties or stitches.

Immediately after: Patient is typically more comfortable, not less. Sedation can often be reduced significantly. I’ve seen it being stopped immediately with good results. Ventilation settings usually stay the same maybe for the next 12 to 24 hours.

Depends on the situation, but often weaning can be started straight away. Again, it depends on the patient’s condition. Ventilation settings, the suction through the tracheostomy keeps airway clear and wound care can begin for the tracheostomy.

The first seven to 10 days after tracheostomy has been done: Wound healing monitored closely. First tube change typically around day seven.

Rehabilitation can begin more aggressively, usually day one. Communication strategies can be introduced much easier. Weaning trials often start or intensify. For detailed guidance during this time, intensivecarehotline.com provides family support and advocacy throughout the ICU journey. Also, one thing that I forgot to mention is once the tracheostomy has been done, there also needs to be a follow-up chest x-ray just to make sure that the tracheostomy tube is in the right place. 

Recovery and Weaning Path 

Now let’s talk about the recovery and weaning path. And let’s talk about, in more detail, what happens after the tracheostomy, because this is where the real benefits show.

Week one to two post-tracheostomy: Significant reduction in sedation and opiates if not complete cessation. Patient therefore becomes more alert and aware. Physical therapy and rehabilitation intensifies, may start sitting up, even standing up with support. Communication boards or digital devices introduced, generally speaking.

Communication is so much easier. Even things like when you have a breathing tube in the mouth, it is so much more difficult to provide mouth care, oral care, brushing teeth, rinsing mouth. Whereas with the tracheostomy, it is so much easier to do proper oral hygiene. Simple things like that.

Week two to four: Ventilator weaning trials become more aggressive. Some patients start using speaking valves.

Swallow assessments may begin. That’s assuming the tracheostomy can be deflated. The cuff can go down. Mobilization needs to continue, some patients walking with portable ventilators, with walking frames and so forth.

Let’s look at week four to eight and beyond: Many patients successfully wean off the ventilator completely. Others establish stable ventilator needs part-time or full-time. One common scenario is nighttime ventilation is needed and daytime is off the ventilator.

Discharge planning can begin, and this is where everything changes. But those who cannot wean either the ventilator or the tracheostomy home ventilation with Intensive Care at Home becomes the goal. And here’s what most hospitals won’t tell you is because someone needs long-term or even permanent ventilation, doesn’t mean they must stay in ICU or in any other facilities or that they must die because there are no perceived alternatives beyond life support.

We’re going to explore this completely in the second half where we talk about the Intensive Care at Home opportunity and option. But first, let me cover the critical questions you need to ask your ICU team, pull out your phone and screenshot this section or grab a pen. These are the questions that will get you the information you need.

Critical Questions to Ask Your ICU Team 

About timing:

• How many days has my loved one been intubated for?
• What’s your realistic timeline for ventilation weaning?
• At what point do you recommend a tracheostomy?
• What are the risks of waiting longer with the current ET tube?
• Are you doing everything beyond the shadow of a doubt to wean my loved one off the ventilator and the breathing tube to get them extubated?

Listen carefully, and are you doing everything beyond the shadow of a doubt to avoid the tracheostomy? And what are the risks of waiting longer with the current ET tube?

Then, you also need to ask questions about the tracheostomy procedure if it’s heading that way:

• Will this be done at the bedside or in the operating room?
• What are the specific risks for my loved one, given their condition?
• How long is the typical recovery from the procedure itself?

About after the tracheostomy:

• What changes can we expect in consciousness and comfort?
• What’s the weaning plan after tracheostomy?
• When could communication or speaking valve be introduced?
• Will they be able to eat and drink?

Then you also need to ask questions about long-term plans, and this is absolutely critical:

• If ventilation is needed long-term, what are all the options?
• Has anyone discussed home ventilation with Intensive Care at Home as an option?
• What discharge options exist beyond long-term ICU stay?
• Can you connect us with a home ventilation program like Intensive Care at Home?

And the last section, questions 12 to 15. Most families never ask because they don’t know home care is possible. And that’s exactly what we’re covering in the second half of today’s presentation. If you need expert help asking these questions and interpreting the answers, that’s exactly what we do at intensivecarehotline.com. We’ve helped thousands of families of critically ill patients in intensive care navigate these critical decisions.

Now, let’s take a 30-second break, grab some water, and let’s shift gears into the life-changing world of home ventilation with Intensive Care at Home, and what life really looks like with a tracheostomy and/or a ventilator outside of the hospital.

Part Two: Transitioning to Home Care with Intensive Care at Home – The Home Care Revolution 

Once again, thank you for watching this presentation. Let’s now talk about the second part, which is the transitioning to home care with Intensive Care at Home, the home care revolution. So welcome back to the second part of this presentation. If you just joined us, hit the subscribe button, hit the like button, click the notification bell, and most importantly, share this video far and wide with everyone that needs to hear this message.

We’re talking about tracheostomy versus breathing tubes, and we’ve just covered the hospital decision-making process. Now, I want to blow your mind with what’s possible that most hospital and ICU teams either don’t know about or won’t tell families. Here’s the reality. When someone has a tracheostomy with or without a ventilator or has a ventilator without a tracheostomy long term or has a tracheostomy and a ventilator, the ICU system often presents two options.

Rec over fully and go home without support, stay in ICU long-term or let your loved one die because it’s not in their best interest to live or a whole lot of nonsense, or in the US, go to an LTAC (long-term acute care) or a skilled nursing facility. Both are disaster areas. I won’t spend too much time on it because I’ve covered LTACs and skilled nursing facilities in the U.S. extensively in a nutshell. Never ever go there.

But here’s the third option that changes everything evidence-based Intensive Care at Home, with 24-hour intensive care trained nurses.

At intensivecareathome.com, we’ve brought, don’t know the numbers, but I’d say probably by now more than a hundred, adults and children home who were told they could never leave ICU or the hospital. Patients with full-time ventilation through tracheostomy, patients with part-time ventilation needs with a tracheostomy, patients with full-time needs of ventilation, but no tracheostomy, patients with part-time needs of ventilation, but no tracheostomy.

Patients with tracheostomy, but no ventilation. Other complex medical needs requiring ICU level nursing and ICU level monitoring. Motor neuron disease, spinal cord injuries, brain injuries, chronic lung disease, cerebral palsy, Rett syndrome, muscular dystrophy, spinal muscular atrophy, Duchenne syndrome, and the list goes on. That includes obviously children and some of them with complex needs right from birth. And here is what makes this revolutionary.

These patients aren’t just surviving at home being able to leave ICU safely. They’re thriving with full community access and dramatically better quality of life than any hospital or ICU can ever provide. Let me show you the evidence and the reality of what this really looks like. First of all, Intensive Care at Home is not experimental or risky. First of all, we are third party accredited for Intensive Care at Home nursing.

Once again, no other service provider in 2026 in Australia has achieved this level of aggregation or has developed the policies, the procedures, the quality manuals, or has the intellectual property that’s needed to provide Intensive Care at Home nursing, because our systems are backed by robust clinical evidence, clinical guidelines. And if you go to our website at intensivecareathome.com, there is a section called the Mechanical Home Ventilation Guidelines, and these are evidence-based.

And they’re not only evidence-based, they’re also a result of over 25 years of Intensive Care at Home nursing in Germany. And we’ve adopted these Intensive Care at Home Mechanical Home Ventilation Guidelines in 2012 when we first got started in Australia and they’ve been proven to be the gold standard. They’ve been proven to be very safe and goes to show that intensive care nurses 24 hours a day at home are the gold standard for long-term ventilated adults and children with or without a tracheostomy or for patients with tracheostomy without ventilation.

So let’s look at what is appropriate patient selection. Ideally, stable ventilator settings, medically optimized condition, family buy-in and support. Number two, comprehensive discharge planning, equipment selection, home environment assessment, emergency protocols established, looking at what needs to be done to keep the client at home predictably and permanently. Qualified Intensive Care at Home nursing team, which is obviously ICU trained nurses 24 hours a day. Ideally, an ICU consultant that can oversee the care or a respiratory physician experienced in home ventilation.

Coordinated emergency response plans, which also includes physiotherapy, OT, speech therapy, dietitian, et cetera. Ongoing monitoring and support, regular medical follow-up, equipment maintenance, family training and education, quality of life assessments. But the research is crystal clear. Intensive Care at Home and home mechanical ventilation is not only safe when properly implemented, but it’s associated with better quality of life scores, lower infection rates than facilities, improved psychological wellbeing, better family cohesion.

Lower long-term costs, increased family and patient satisfaction, and its evidence-based nursing and medicine, not wishful thinking. At intensivecareathome.com, we follow these evidence-based mechanical home ventilation guidelines rigorously. We ensure our third-party accredited policies and procedures to ensure every patient can be at home safely. Comment below. Did you know that home ventilation and Intensive Care at Home was even possible?

Quality of Life at Home: Community Access and Real Living 

Now, let’s look at quality of life at home. Community access and real living. Let me paint you a picture now of what life actually looks like for our clients, adults and children at home with Intensive Care at Home compared to staying in ICU. In an ICU, you have restricted visiting hours. Institutional routines and schedule, limited personalization. No pets, limited personal belongings, shared rooms or clinical environment, noise and disruptions 24/7, minimal community contact, depression and isolation is very common. Life revolves around medical care, how the intensive care team sees fit.

No choice of staff. No choice of doctors. It’s often a one size fits all approach. And also in a hospital, you have no community access. You’re stuck in an ICU bed in an ICU cubicle and you have no access to daylight, to natural daylight, to fresh air. You often don’t get a shower.

Let’s look at what that looks like at home with Intensive Care at Home. It’s your home, it’s your environment. Your family is present whenever you want. Your pets, your belonging, your belongings, your comfort. Normal day and night routines, a good night’s sleep. Meals of, you choose when you want them.

Windows with natural daylight, privacy and dignity, choice of staff, who you want, who you choose who should look after you. Privacy and dignity, community access. You can have a shower at home or a bath. But here’s what really sets us apart. Full community access, our patients with tracheostomies and ventilators. Go to shopping centers, go to restaurant and cafes, attend family gatherings and celebrations, go to parks, beaches, shopping centers, attend church, temple, or mosque. Go to the movies. Children attend school or social programs. Adults can participate in hobbies and interests. If their condition allows, visit friends and extended families, have friends and extended family coming to their home. That’s why we provide 24/7 intensive care level nursing that travels with the patient. Our nurses are trained for manage portable ventilators in the community. Prevent emergencies, but also handle them if they do come up, suction and perform tracheostomy in any environment, monitor vital signs continuously, coordinate with medical equipment, ensure safety while maximizing experience. This is not about being home bound with medical equipment, this is about living life with the medical support you need. Go and check out intensivecareathome.com to see photos and videos of some of our patients living full lives in their communities.

Let’s now also look at some case studies. Let’s start with the adult side. Adults with tracheostomy and ventilation at home. Here are some real world examples.

Motor neuron disease: We have two, three motor neuron disease clients at the moment. All of them live with full-time ventilation, two of them live with full-time ventilation and tracheostomy. And there’s another one that lives on part-time ventilation with BIPAP.

They were told by the hospital that spend their remaining days in an ICU and that they should just stop everything because there won’t be any quality of life if they do survive or if they choose to have long-term ventilation and tracheostomy. That’s what they were told by the hospital. We brought all of these clients’ home from ICU with 24/7 intensive care nursing. All of these clients are now living at home. They can be with family, be with their children, with their spouses. And the quality of life has been absolutely transformed.

A bleak outlook of staying in ICU long term or the ICU team pushing for end of life decision saying, “Oh, it’s not in the best interest of your loved one to live. It’s in the best interest for them to die.” Well, ICU teams to say that. Well, ICU teams to make decisions about life or death. That’s up to the patient, that’s up to the families.

Let’s look at some spinal cord injuries: Often C1, C2 spinal injuries. Again, we have a number of patients there that have C1 or C2 spinal injuries. And they spend months, if not years in hospital, before finally transitioning home with Intensive Care at Home. Again, they go out, have a social life, have a family life, have even been traveling. We have been on airplanes with those clients or just going for a weekend away with their family. All of that is possible. And what’s interesting also, patients and families have a choice and ICU teams often paint a negative picture of saying things like, “Oh, if it was my family member, I wouldn’t want them to live.” Well, that’s fine. It’s not your family member and it’s up to the patient and the family what they perceive is a good quality of life for their circumstances. And everyone’s situation is different. You can’t approach situations like that as a one size fits all approach and say, “Oh, if your loved one can’t come off the ventilator, they will have no quality of life or they can’t live at home and all this nonsense.”

Again, Intensive Care at Home is evidence-based. It’s been around for over 25 years in mainly Germany and in Australia and it’s evidence-based. It’s safe. Hundreds and hundreds of case studies. Your loved one can be a case study too. And I mean that a positive case study.

Let’s also look at some chronic respiratory failure clients: For example, we had a client that had lung cancer, progressive lung cancer, stuck in an ICU on BIPAP, and we took him home for palliative care. He spent about three months at home before he passed away peacefully in his own home, surrounded by his family. He said he never, ever wanted to go back to ICU ever again. And again, that was a much better death than dying in hospital.

And all of these examples are not exceptions. This is what proper home, Intensive Care at Home makes possible. The key is having 24/7 ICU trained nurses who know how to manage complex ventilation, tracheostomy, who know how to prevent emergency situations and enable community participation safely. That is the Intensive Care at Home difference. And once again, most of those patients and families would’ve been told in ICU, your loved one won’t have any quality of life at home and that it’s quote-unquote in the best interest to die.

And again, you have to ask the question, where’s the rush? Where’s the urgency to kill someone? Have a think about that.

Let’s now talk about children with tracheostomy and ventilation at home, because this is where home care becomes absolutely critical for development of those children and quality of life. Children with tracheostomies and ventilators can and should be at home whenever possible. And here’s why, and they should be at home whenever possible with 24-hour intensive care nurses.

Anything less than that would be a death sentence. And here is why, developmental needs, children that need normal family bonding, exposure to language play, social interaction, age-appropriate stimulation, emotional security of parents and siblings, normal sleep, wake cycles.

Again, here are some case and success stories:

Infants with complex needs: Born prematurely, requiring tracheostomy and ventilation pretty much from birth, six months in PICU (pediatric intensive care unit), brought them home after about 12 months’ time or after 12 months in ICU. Got ventilated initially with a tracheostomy and then we gradually weaned those toddlers off the ventilator and eventually they got decannulated. So now they’re living a normal life without a ventilator and a tracheostomy, and that is just such amazing success stories. 

We also have other children with spinal muscular atrophy. For example, nine-year-old girls, spinal muscular atrophy, BIPAP dependency mainly overnight, coughs during the day, PEG tube, they attend full daycare or school with their peers. We take them to school and their lives are normalized as much as possible. So it’s all possible.

Now, on a maybe more serious notes as well, we have also done palliative care for pediatrics at home, taking kids home from ICU, for palliative care, as sad as that is, it’s still the best place for children to pass away if that is the only option. But the bottom line is whether it’s for adults or for children, the evidence is overwhelming adults and children do better at home in every measurable way, developmentally, psychologically, medically, and socially.

At intensivecareathome.com, we specialize in pediatric home ventilation with nurses trained in both ICU care and child development. We don’t just keep children safe. We help them thrive. Comment, did you know children could attend school with full-time ventilation and tracheostomy?

Making the Transition: The Discharge Process from ICU to Home 

Let’s now look at making the transition, the discharge process from ICU to home. So you’re thinking, “This sounds amazing, but how do we actually get there?” Let me walk you through the transition process.

Obviously, there needs to be an early discussion while still in ICU. Contact us at Intensive Care at Home as soon as the tracheostomy is being discussed. We can assess eligibility even while patient is in ICU. Begin discharge planning early. Don’t wait for hospital to suggest it. Also, utilize intensivecarehotline.com for ICU advocacy during this phase. Patient needs stable ventilator settings, medically optimized for transition. Tracheostomy wound should be healed, which usually happens after seven to 10 days post-tracheostomy procedure. Care routines need to be established.

Step three, home assessment. Our team evaluates your home environment, electrical requirements for equipment. Space for nursing staff, emergency access, any modifications needed, which are often minimal.

Next or step number four, equipment set up. Hospital grade ventilator for home use, backup ventilator required for safety, two suction machines, oxygen supply, which can either be via cylinders or an oxygen concentrator or ideally can be both. Monitoring equipment, emergency supplies, but also other stocks such as suction catheters, spare tracheostomy tubes, PEG tubes, IDC or SPC, if that’s what’s needed.

Our nursing team obviously is trained on specific patient needs. We can also start with some training shifts in hospitals. Not that we need the technical skills, but we need to learn about your loved one or we need to learn about you if you’re watching this as a patient. We need to know about your preferences, about your routines and how care should be performed. Every patient is different and care needs to be individualized. We strongly believe in that.

Obviously, we have emergency protocols that we follow, but before we even do that, our staff are trained to prevent emergencies in the first place. Then, we implement a 24-hour nursing schedule or nursing roster to go home. Obviously, there’s a coordinated discharge day, ambulance or medical transport with our nurse. Full nursing team is ready at home. Physician follow-up is scheduled equipment is all organized. Ongoing is obviously 24-hour ICU nursing care in your home, regular physician visits or telehealth, physiotherapy, equipment maintenance, community access, facilitation, quality of life, optimization.

This typically takes two to four weeks to coordinate from the decision point to actual discharge. We handle the complexity you focus on your family and your family only. Go to intensivecareathome.com to start the conversation today.

Now, also now, you’re wondering about cost. Let’s be transparent about the financial reality. ICU beds cost between five to $10,000 per bed day and an Intensive Care at Home stay, 24-hour care is about 50% of that. So the economic argument is there, right? So the costs vary slightly on locations.

What I mean by that is an ICU that’s located in a rural area, for example, is more expensive than an ICU that’s in a metropolitan area, it’s simply more expensive to get staff to a rural ICU. And it’s the same if a client is in a metropolitan area, that’s much more cost-effective to set up than if a client is in a rural area. But at the end of the day, it’s still around 50% of the cost of the ICU bed. Obviously, there’s equipment and supplies, doctor oversight. We have our own ICU doctor, but at the bottom line is we’re talking about 50% of cost reduction compared to an ICU and better outcomes and quality of life.

Who’s paying for it? Depends on your unique circumstances. In Australia, NDIS pays for it. TAC, DVA, Department of Health, sometimes hospital can pay for it. Private health insurances can cover it. And so sometimes also long-term insurance plans may pay for it. Some worker compensation cases, WorkSafe, for example. Our process, we verify insurance coverage before commitment, work with case managers and insurers, help families understand benefits and options, creative solutions for complex situations, transparent cost discussions upfront.

Also, we are also providing level two and level three NDIS support coordination. If you are eligible for NDIS funding, you should talk to us about level two and level three NDIS support coordination so we can help you with getting the funding approved. The bottom line is that the financial argument for Intensive Care at Home is very compelling, better outcomes at lower cost, but the real value is quality of life and cannot be measured in monetary terms.

Again, for detailed funding questions specific to your situation, contact us at intensivecareathome.com for the next steps.

Now, also a question to ask any home care providers. Not all home care is created equal. If you’re considering any home care provider for ventilation, Intensive Care at Home, ask these questions. Are all your nurses’ ICU trained or just some? Are you actually accredited for Intensive Care at Home? And once again, I argue in 2026, we are the only service in Australia in 2026 that has actually got third-party accreditation for Intensive Care at Home. It’s such a unique skillset, such unique intellectual property that not many, if any, know how to do it properly.

Ask any other providers, how do they handle emergencies? Have they had any success in advocating for funding successfully? What’s your nurse retention rate? How are your nurses trained on our specific equipment and needs? How many ventilated patients have they served? Are they third party accredited? Do they have pediatric cases? Can they provide references from similar cases? What’s their track record with hospital readmissions and what’s their track record with preventable deaths? Do you support community outings?

Will nursing staff travel with patients? What training do nurses receive for community settings? Can you show examples of community participation? Also, ask them if they have clinical governance. We have clinical governance here at Intensive Care at Home. We have a whole team of senior nurses overseeing the care. We have our own intensive care specialists on the books. Most other providers do not have any of it.

What are their processes if equipment fails? How do you coordinate with doctors, other nurses? How do you coordinate rosters? Do they have a roster team, a designated roster team, which we have at Intensive Care at Home? At intensivecareathome.com, we welcome these questions and can provide detailed answers, references, and track record documentation. We’re proud of our outcomes and our patients’ quality of life. Don’t settle for basic home care where providers are not accredited for Intensive Care at Home. We’ve done all the hard yards. Do not settle if they don’t have any ICU level expertise. Your loved one only deserves the best.

So let’s look at the key takeaways before we wrap this up because we’ve covered so much in the last hour. Let me summarize the key points.

On tracheostomy versus breathing tube:

• ET tubes are for short-term use only, under 14 days ideally
• Tracheostomy is recommended when ventilation extends beyond 14 days
• Tracheostomy is more comfortable, safer, and enables better recovery
• It’s not giving up. It’s often the turning point towards progress

On ICU care:

• Ask the right questions about timing and options
• Understand the weaning process
• Know that prolonged ICU or facility stay isn’t the only option

Intensive Care at Home:

• Intensive Care at Home is the only third-party accredited provider in Australia in 2026 for Intensive Care at Home
• We follow the evidence-based home mechanical ventilation guidelines
• It’s evidence-based and safe
• Quality of life at home far exceeds any ICU stay
• Community access is possible with proper support
• Adults and children can thrive with tracheostomy and ventilation at home
• 24/7 intensive care level nursing makes all the difference

The decision about tracheostomy isn’t just medical. It’s about what kind of life you want for your off one down the line. And with the right support, that life can be full, rich, and meaningful at home.

So once again, if you need ICU level support and advocacy in ICU, go to intensivecarehotline.com where you get expert guidance when your loved one is critically ill, help understanding medical recommendations, second opinions and treatment plans, support navigating the ICU system.

Advocacy in family meetings with intensive care teams when you need a voice. For home ventilation, tracheostomy in Intensive Care at Home, visit intensivecareathome.com, explore evidence-based Mechanical Home Ventilation Guidelines, see patient stories and outcomes. Request an assessment for home care eligibility, 24-hour intensive care nursing care at home, full community access support.

Now, also, if you like the video today, subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home.

Click the like button, click the notification bell, share the video with your friends and families or anyone who needs to hear this message.

And I know if you’re watching this, you’re probably facing one of the most difficult situations in your life, whether you’re in ICU or your loved one is in ICU and you’re making decisions about tracheostomy or no tracheostomy, or if you have a loved one at home already and you realize your current setup is not working, you have more options than you’ve been told your loved one can come home if you want to pursue that. Once again, go and visit intensivecarehotline.com for ICU support and go and visit intensivecareathome.com for Intensive Care at Home options.

Thank you for watching. I’ll see you again next week around the same time for another YouTube live and go and watch my videos that are coming out during the week with updates for families in intensive care.

Take care for now.

With all of that said, with Intensive Care at Home, we are currently sending our critical care nurses into the home 24 hours a day. Therefore, we are providing a genuine alternative to long-term stay in intensive care for:

• Ventilation
• Tracheostomy
• Home BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure)
• Tracheostomy care without ventilation
• home TPN (Total Parenteral Nutrition)
• Home IV potassium
• Home IV magnesium
• Home IV antibiotics
• Home IV fluids

We’re providing:

• Cough assist management at home
• Ventilation weaning management at home
• central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line as well as port management at home
• nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy), PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home
• IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home
• Palliative care services 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 Health District’s In Touch program, saving approximately $2,000 per patient that we keep at home instead of them going into an emergency department.

That also means we’re in a position to cut the cost of an ICU bed by around 50%. An intensive care bed costs between $5,000 to $10,000 per bed day depending on location. Intensive Care at Home costs approximately 50% of that, 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.

 

Our Coverage and Accreditation

 

With Intensive Care at Home, we’re currently operating all around Australia, in all major capital cities, as well as in all regional and rural areas. We are an NDIS approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria as well as the Department of Veterans Affairs all around Australia.

We’re also ISO 9001:2015 accredited. 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 the only service provider in Australia that has achieved third-party accreditation for Intensive Care at Home nursing in 2025. We have been achieving this high level of accreditation since 2012. No other provider in Australia has achieved the Intensive Care at Home level of accreditation in the community and 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. And that enables us to look after the highest acuity adults and children in the community in Australia safely.

 

If You Need Help

If you’re at home already and you’re watching this or you’re stuck in an ICU and you realize that you don’t have the right level of support, I can give you many examples where we helped clients with funding, how we advocate for funding. We had to advocate successfully for funding from our first case study to many other case studies where we had to advocate successfully for funding with the right evidence of course because it is crystal clear that disability support workers for example or registered nurses without ICU experience cannot look after ventilated clients at home whether adults or children with or without a tracheostomy and it’s simply dangerous and negligent.

There are plenty of examples where clients with support worker models or even RN (registered nurse) models without ICU experience have died at home and I have evidence to back up everything that I’m saying here because it’s a bit like flying the airplane with a cabin crew instead of the pilot and it could simply be deadly.

This can be avoided by having simply 24-hour critical care nurses at home because our clients are at high risk of medical emergencies or worse without critical care nurses 24 hours. This is actually also evidence-based in the community and is documented in our evidence-based Mechanical Home Ventilation Guidelines on our website at intensivecareathome.com.

Think about it: in an intensive care unit in a hospital, you wouldn’t have support workers or general registered nurses looking after a critical care patient on a ventilator with a tracheostomy. So why would anyone in their right mind do that in a home care environment where there are fewer resources?

Clients that have found us have been at home long-term predictably and permanently with critical care nurses. Their alternative would have been to either die or stay in ICU long-term, and our clients don’t go back to ICU. They stay at home permanently and predictably and the insurance bodies save half of the cost of an ICU. But it’s a win-win situation all around.

We can do the same for you if you’re stuck in ICU or if you’re not safe at home, which includes the advocacy for funding and the network that goes along with it. We have always successfully advocated for our clients or we have the network to successfully advocate for you and for your family member, otherwise we wouldn’t be in business. The same again is applicable for those stuck in an ICU which is similar to many of our, if not most of our cases.

 

Our Support Coordination Services

This is also why we are providing Level 2 and Level 3 NDIS support coordination. We have a team of experienced NDIS support coordinators, and they have a wealth of knowledge. 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 or a social worker from another organization or a hospital watching this and you’re looking for nursing care for your participants, please reach out to us as well. If you’re looking for funding for nursing care for your participants and you don’t know how to go about it and how to advocate for it, what evidence to provide, I encourage you to reach out to us as well. We have the network to make that happen. We will help you with the right level of funding and with the right level of advocacy.

 

We’re also providing NDIS specialist nursing assessments done by critical care nurses with a legal nurse consulting background.

Join Our Team

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

If you’re looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, Albury-Wodonga, Bendigo, Geelong, Warragul, and also in Wyelangta in Victoria.

 

If you have worked in critical care nursing for a minimum of two years, adult ICU, pediatric ICU, ED and you have already completed a postgraduate critical care nursing qualification, we will be absolutely delighted hearing from you.

 

I have a disclaimer though: Because we are offering tailor-made solutions for our clients which includes regular staff, our clients do also want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular, reliable staff.

If you’re looking for agency work where you can come and go, this will not be the right fit for you. We’re 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 relationships with us and with our clients. Reliability is also a must.

 

For Medical Professionals and Healthcare Executives

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 to 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 settings, and you get the same level of care and simply more patient and family satisfaction because you also want to partner with your consumers.

If you are a hospital executive watching this, we can help you free up your ICU and ED beds.

 

International Support

If you’re in the U.S. or in the UK 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, click the like button, 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, and share this video with anyone who has a family member in intensive care long-term or needs to see this.

Thank you so much for watching. 

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

Take care for now.