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My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomy, where we provide tailor-made solutions for long-term ventilated adults and children on bilevel positive airway pressure (BiPAP), continuous positive airway pressure (CPAP) ventilation at home, where we provide tailor-made solutions for tracheostomy adults and children without ventilation at home, home ventilation weaning, home cough assist management, and home tracheostomy weaning, home total parenteral nutrition (TPN), home intravenous (IV) fluids, home IV antibiotics, home IV potassium, magnesium, and other electrolyte infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, port management at home, indwelling catheter (IDC), suprapubic catheter (SPC), nasogastric tube, nasojejunal tube, percutaneous endoscopic gastrostomy (PEG), percutaneous endoscopic jejunostomy (PEJ) tube management at home, as well as palliative care management at home.

We are also providing level 2 and level 3 National Disability Insurance Scheme (NDIS) support coordination, as well as Transport Accident Commission (TAC) case management.

 

In today’s video, I want to answer a question from Belinda, whose mom is in ICU with a tracheostomy and on a ventilator, and Belinda writes to me,

 

“Hi Patrik, 

My mother is in an ICU with a tracheostomy and on a ventilator. She is able to do her spontaneous breathing for 24 hours; however, when she is taken off the ventilator, her heart rate drops. Now we think our only option is that she has to come home on a ventilator. My question is, can she do some weaning at home, or is weaning only possible in ICU at the hospital?”

 

Thank you, Belinda, for sending in that question and trusting me with my answer.

Before I answer, I want to acknowledge something very important.

 

Belinda, the fact that you are asking this question at all puts you ahead of most families I speak with. You are not just accepting whatever the ICU team tells you. You are actively advocating for your mom, asking the right questions, and looking for options beyond the hospital walls. That is exactly the kind of advocacy that changes outcomes in intensive care. It is why I wanted to answer your questions publicly, so we can help other families in the same position.

 

Let us now break down what Belinda has described because it is a really common and really important scenario. Belinda’s mom can tolerate 24 hours of spontaneous breathing off the ventilator. That is genuinely encouraging, and it tells us her respiratory drive and lung function are likely reasonable. But when she is taken off the ventilator completely, her heart rate drops.

 

That is the critical detail because it shifts the problem from being purely a lung and breathing issue to potentially being a cardiac or autonomic issue as well. A drop in the heart rate, which is also known as bradycardia, when coming off ventilator support can happen for a number of reasons, including increased vagal tone during the stress of unassisted breathing, an underlying cardiac conduction issue, electrolyte imbalances, medication effects, or simply the physiological strain of the work of breathing without support.

 

This is exactly the kind of detail that needs proper cardiac and respiratory workup before anyone decides she is stuck on a ventilator in ICU long term. Let us now come to the critical question here, which Belinda asked, which is, can ventilator weaning happen at home or only in hospitals?

 

Here is a direct answer to Belinda’s question. Yes, in many cases, weaning can continue at home, and for a lot of families, it is actually a better environment to do it in. Hospital ICUs are set up for acute, unstable patients. They are noisy, they rotate staff, and they are not designed for the slow, patient, incremental processes that ventilator weaning often requires once someone is medically stable enough to leave.

 

Weaning is not a single event. It is a gradual process of increasing time off the ventilator, monitoring closely, and adjusting based on how the patient tolerates it. That process can absolutely be done at home, provided it is done with the right level of intensive care nursing and intensive care oversight.

 

This is where the level of nursing matters enormously. Weaning a ventilator-dependent patient safely, especially one who has already shown a cardiac response like dropping heart rate, is not a task for a general registered nurse, or let alone a disability support worker or basic home care nurse.

 

Similar to an ICU, it requires 24-hour critical care registered nurses who understand ventilator settings, can recognize early signs of decompensation, and know when to pause weaning, escalate weaning, or call for a medical review, know when to do arterial blood gases or capillary blood gases.

 

Here at intensivecareathome.com, our clinical approach to weaning, ventilator settings, and monitoring is based on published evidence-based mechanical home ventilation guidelines, which you can read on our website, and I will link to our evidence-based mechanical home ventilation guidelines in the show notes.

What needs to happen before weaning actually starts at home? A clear cardiac and respiratory workup to understand why your mother’s heart rate drops off the ventilator. This needs to be answered before, not after discharge to Intensive Care at Home.

 

Next, a documented weaning plan from the ICU respiratory team, including targeted times off the ventilator, parameters to monitor, and clear escalation criteria. 24/7 critical care registered nursing at home, not just home care, so someone qualified is watching heart rate, oxygen saturation, work of breathing, ventilator settings, and consciousness levels continuously during weaning trials. Also, someone that can instigate blood gases to see where weaning might be at.

Next, it needs equipment at home that matches the ICU standard, the same caliber of ventilator equipment, suction equipment, tracheostomy equipment, monitoring, and emergency equipment she has in ICU. One of the most important pieces of advice I can give every family in this situation is that you request your mom’s medical records and progress notes directly from the hospital. Do not wait for someone to summarize it verbally in a five-minute family meeting.

 

In the records, you will find the actual documented reasons for the bradycardia, previous weaning attempts, arterial blood gas results, chest X-ray results, magnetic resonance imaging (MRI), computed tomography (CT) scan results, doctors’ reports, nurses’ reports, vital sign trends, ventilator settings, fluid balance charts.

 

Leave no stone unturned.

 

Because this information you need to ask informed questions and to make informed decisions and to make sure home ventilator weaning is planned properly, not just assumed to be impossible without all the details. If you are not sure how to read the medical records, what to ask for, or how to interpret what you are seeing, that is exactly what I help families with.

 

If you want tailored advice on your mom’s specific situation, how to go home, her ventilation weaning plan, how we can continue that at home, the cardiac workup, how to advocate with the ICU team, how to get medical cover at home, just reach out to us here at intensivecareathome.com.

 

Call us on one of the numbers on the top of our website or book a call with me. There is a schedule appointment button on the website, or give me a call.

My direct mobile number here in Australia is 041 094 2230. That is again, 041 094 2230.

 

If after the proper workup, the ICU and cardiology team agree that ongoing ventilation support and weaning is best continued at home, that is exactly what Intensive Care at Home was built for.

 

We provide 24-hour critical care registered nurses for invasive ventilation with tracheostomy, non-invasive ventilation without tracheostomy, tracheostomy without ventilation.

 

Right across all states and territories in Australia, all metropolitan, all regional, all remote areas.

 

We are proud to be Australia’s only third-party accredited and NDIS registered provider for Intensive Care at Home nursing, and you can see our full accreditation and quality standards on our website at intensivecareathome.com/accreditationquality.

 

Again, I will link to it in the show notes.

 

We have built the policies, the procedures, the intellectual property that leads us to third-party accreditation. We also have the team. We are employing hundreds of years of critical care nursing experience combined in the community, bringing a very high skill level in the community. What that means is that the accreditation, the skills we bring into the communities, it means that when you bring your mom home, she is cared for to the same clinical standard as in an ICU, not a lower one.

The bottom line, Belinda, is that weaning off the ventilator does not have to only happen inside of an ICU or a hospital. With the right cardiac workup, a proper weaning plan, and genuine 24/7 ICU-level nursing at home, your mom may well be able to continue weaning in the comfort of her own home rather than staying in ICU indefinitely.

 

Thank you for advocating so hard for her.

 

Keep asking these questions because they are exactly the right ones.

Like I said, contact me at intensivecareathome.com. Call me on one of the numbers on the top of our website, or schedule an appointment with me through the schedule appointment button, or send us an email to info@intensivecareathome.com.

 

If you are watching this and you are in the United States, in Canada, in the United Kingdom, in India, anywhere around the world, please reach out to us as well.

We can help you there privately.

 

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.