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“Can a patient on CPAP (Continuous Positive Airway Pressure) in ICU go home with Intensive Care at Home on 50% FiO2 (fraction of inspired oxygen) with pulmonary vasculitis and TPN (Total Parenteral Nutrition)?” The patient has no other pre-medical history, so let’s look at this.

My name is Patrik Hutzel from intensivecareathome.com.

Let’s look at this question from an inquiry that we had this week. It’s a great question, let’s walk through it carefully. The short answer is yes, it is possible for a patient on CPAP with 50% FiO2, pulmonary vasculitis and TPN, TPN stands for total parenteral nutrition via central line or a PICC (Peripherally Inserted Central Catheter) line to go home with the right Intensive Care at Home team. It is fairly complex, and it depends on a few key factors, but that’s what we do at Intensive Care at Home, making sure those few key factors are aligned.

So in the ideal world, CPAP would be less than 40%, that would be even safer. The lower the better, of course, because 50% of their value is fairly high. Just for your information, room air is 21%. So the air that you and I are breathing is 21%, so 50% is fairly high. Like I said, to go home would be much better if it was down to 40%, so it is indicating that it’s a moderate respiratory support condition.

Home CPAP machines can deliver higher FiO2 if connected to oxygen concentrators, but it would require high-flow oxygen set up with an Airvo as well and constant monitoring. Because if a patient can only have short periods of time off the CPAP, they need an Airvo and a high flow nasal oxygen so that when they eat and drink, they can get enough oxygen. Now, if a patient in a situation like that, cannot wean to lower oxygen needs, they would need input from obviously respiratory doctors, ICU consultants which we have on our team as well.

So next, let’s look at pulmonary vasculitis. It’s a serious lung condition that can worsen suddenly like a flare or even a bleed. With Intensive Care at Home, the team would need to be ready for emergencies, ideally, nurses trained in critical care, which is what we are providing here at Intensive Care at Home anyway. Also, immunosuppressive therapy like steroids or other medications would probably be involved, so infection control at home is critical. However, bear in mind, the home care environment is also much cleaner than a hospital environment where critically ill patients are surrounded by bugs from other patients that doctors and nurses usually can carry around very easily.

Let’s look at the TPN side, total parenteral nutrition. Basically, it is intravenous nutrition. Being on TPN at home is common for some patients, but it needs very strict sterile technique to prevent bloodstream infections such as sepsis. I can tell you, we have been running a number of home TPN programs over the years for pediatrics and adults, so that means the Intensive Care at Home team must know about central lines or PICC line or Hickman’s line or potentially a port-a-cath, which again is skills we have on our team.

So, it’s good that there’s no pre-medical history. It means that the chances for better recovery compared to someone with multiple chronic illnesses is much improved.

So, what is needed at home? 24/7 intensive care nurses, ideally input from an intensive care consultant or a respiratory physician, ideally both, to oversee CPAP oxygen weaning and emergency backup plans, regular labs, and doctor oversight, of course. Also, some indicators when hospital admission is necessary, with some emergency plans, especially if breathing worsens or an infection develops, and then, obviously, TPN management team with pharmacy, gastroenterologist, dietitian, and the nursing team.

What are the biggest concerns here? Obviously, can oxygen needs be lowered? Like I said, it would be great if FiO2 can be lowered to less than 40%. Are they medically stable? Otherwise, and I know in this situation, the patient is not on inotropes or vasopressors. He’s got a sinus rhythm, he’s not in an irregular heart rhythm.

Then obviously, what’s also important at home is that the home set up is safe. Enough space, a hospital bed, ideally a hoist, and an air mattress. Also, monitors, suction machine, backup ventilator, two suction machines as a matter of fact, to have backup as well. Backup power, especially for the TPN, we need an infusion pump. So in summary, it is possible to take this patient home with Intensive Care at Home if all supports are in place and the patient is stable without rapidly changing the respiratory or cardiac status.

Therefore, Intensive Care at Home discharge is doable and it is on offer in many countries, and companies now offer that kind of service for complex patients like we have done since 2012 in Australia. Services like Intensive Care at Home have been around since the late 1990s in Germany, and I’ve worked in this space in Germany as well. It’s also been around in India for a long time, so shout out to my friends in India and in Germany. These services have been around in many countries for a while now, for over 25 years, as a matter of fact.

So, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24 hours a day. That means, we are providing a genuine alternative to long-term stay in intensive care for ventilation, tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy, tracheostomy without ventilation, Home TPN (Total Parenteral Nutrition), home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics. We’re also providing ventilation weaning at home. We’re also providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home. We’re also providing nasogastric tube and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home as well as palliative care services at home. We also use cough assist machines for our clients for airway clearance.

We are 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 the emergency department.

That also means we’re 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 cost between $2,500 to $3,000 per day and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. But 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 at home is much improved surrounded by families.

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’re an NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as the Department of Veteran Affairs (DVA) all around Australia. Our clients and we, as a provider, have also received funding through public hospitals, private health funds, as well as departments of health.

We are currently 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 level of accreditation since 2012. No other service provider has achieved this high level of accreditation in the community and has created more intellectual property for 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 if you’re stuck in an ICU, or if you’re going to hospital and ED (emergency department) all the time, and you realize that you don’t have the right level of support, I’ll give you another tangible and real-world example today, very similar to the one I gave you a minute ago.

One of our first clients when we first got started over 10 years ago, 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 dangerous and negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy is like flying the airplane with the 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 critical care nurses looking after them 24/7. This is actually evidence-based and it’s 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 a critical care patient on a ventilator with a tracheostomy. So, why would anyone in their right mind would do that in a home care environment in the community?

So, this client found out about us eventually and the ICU that he went back to all the time also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with the client, we sent him intensive care nurses, 24 hours a day. He never, ever went back into ICU ever again and we were proving our concept there very fast.

We can do the same for you if you’re not safe at home which includes the advocacy for funding that goes along with it. We have always successfully advocated for our clients. Otherwise, we would not be in business. The same is applicable for those stuck in an ICU, similar to our case study today, or going back to ED all the time, so what you’re looking for? Reach out to us, we’ll make it happen for you as well. We can take you through the right steps including NDIS or other funding bodies, and the advocacy that needs to go along with it.

Which is also why we are providing Level 2 and Level 3 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’re looking for funding for nursing care for your participants, and you don’t know how to go about it and what evidence to provide, I encourage you to reach out to us as well. 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.

If you are a critical care nurse and you’re looking for a career change, and you want to join a very progressive, dynamic, high-performing team of critical care nurses in the community, we are employing hundreds of years of critical care nursing experience combined. If you are looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, and 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 have a disclaimer, 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 very vulnerable and very special, and 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 if you’re really keen on building relationships with us and with our clients.

If you are 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 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, 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. or 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 the video with your friends and families, and comment below what you think about this video or what you want to see next.

Thank you so much for watching.

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

Take care.