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Can My Mother with Stage 4 Lung Cancer, Tracheostomy, Ventilator, PEG (Percutaneous Endoscopic Gastrostomy), Cardiac Arrest Go Home from ICU?

If you want to know if a patient in intensive care with a collapsed left lung, tracheostomy, Stage 4 lung cancer, and PEG (Percutaneous Endoscopic Gastrostomy) tube can go home, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecareathome.com, and I have an email today from Camille who asks the following,

“Hi Patrik,

My mom has been in and out of ICU for the last 6 months. She has Stage 4 lung cancer with a collapsed left lung, tracheostomy, and she has a PEG tube. She had initially started to walk again, eat, drink, and speak with the speaking valve, but she was recommended that she go back to ICU for blood coming out of a tracheostomy.

After Day 1 at the hospital, she went into cardiac arrest due to not being able to ventilate from the blood clots coming out of the tracheostomy. The ICU doctor told us she was not going to make it through that night. After one week, they tried to put in a stent, but they were unable to due to blood accumulating in the left lung.

They also found out that there is a tumor there as well during the bronchoscopy. They recommended that she be put on comfort care and hospice, but we refused as her wishes are to continue treatment and to go home eventually.

After 3 weeks, she was transferred into the step-down ICU and she’s now fully awake and alert. We’ve asked the ICU team about her cancer treatments, but no one is giving us any answers or any other recommendations besides hospice and end of life care.

What should we do, and can she go home?”

Well, thank you so much, Camille, for reaching out and for sharing your mother’s situation.

Look, as long as she is hemodynamically stable and she’s not on any inotropes or vasopressors, she can go home.

Now, as far as the treatment for the cancer is related, you have to ask probably the oncologist, the cancer specialist, and the pulmonologist. The ICU team is not the expert in cancer treatment. That’s the people you need to ask.

But if, for whatever reason, the cancer is incurable, again, I wouldn’t know with the information that you’ve shared if the cancer is untreatable, then possibly going home for palliative care or end of life care might be the best option here. But if the cancer is treatable, then you should be asking and pushing for treatment and then she can still go home.

Here’s the issue with cancer treatment in ICU or in the hospital in general. When radiotherapy or chemotherapy is done, patients are often extremely immunocompromised. A hospital environment makes them very prone for getting an infection because if you’re in a hospital, it’s sort of a “dirty” environment, you’re surrounded by all these other sick patients with infections and bugs, whereas at home, it’s a “clean” environment.

So going home, even though your mom has a ventilator and a tracheostomy, makes perfect sense. She can have cancer treatment as an outpatient, and sometimes chemotherapy or can be done at home as well. So, those are my recommendations here.

There’s nothing that we haven’t done before at home. So, it is certainly something that can be done with Intensive Care at Home, there is absolutely no issue there. But the cancer treatment, you need to find out what that looks like next.

Also, with bleeding from the tracheostomy, you also have to find out if she’s on any anticoagulation or if she has any other bleeding disorder. I remember a few years ago, we had a client at home who was also occasionally bleeding from their tracheostomy. Now, we could manage that at home, it’s just a matter of having a plan in place, whether any medication such as tranexamic acid can be given at home, just need to have a script for it. It’s all a matter of prior preparation and planning so that these situations can be managed at home safely.

So, I hope that answers your question, Camille. Reach out again if you want to take the next steps of taking your mother home. We can certainly set up the team for you. We can help you with the finance, that’s all part of what we do because patients like that should be at home and not in an ICU or in a hospital.

Now, with Intensive Care at Home, we’re providing 24 hours critical care nursing at home. Therefore, we are providing a genuine alternative to a 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), and home IV potassium infusions, and home IV magnesium infusions. 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-a-cath management. We’re also providing palliative care at home. We’re also providing nasogastric tube management and PEG tube management 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 going to the emergency department.

We’re also therefore in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs around $5,000 to $6,000 per bed day. Our service 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, so it’s a win-win situation for all stakeholders.

With Intensive Care at Home, we’re currently operating all around Australia and all major capital cities, as well as in all regional and rural areas. We are 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 for 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 2024. We have been achieving this level of accreditation since 2012. No other provider has achieved this high level of accreditation in the community and has created more intellectual property for Intensive Care at Home than we have. That puts us in a position to employ hundreds of years of critical care nursing experience combined in the community. No other service provider in 2024 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, and you realize that you don’t have the right level of support, I’ll give you a very tangible example today. One of our first clients over 10 years ago was a client who was at home on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers cannot keep a patient at home on a ventilator with a tracheostomy. That 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 dying and he was going in and out of ICU because support workers simply do not have the skills, the experience, the knowledge, or professionalism to look after a ventilator and a tracheostomy client. It’s an intensive care nursing skill, a critical care nursing skill only. It’s not even the skill of a general registered nurse.

Eventually, this client found out about us. We were proving our concept with this client very fast. When we worked with the client, we sent him intensive care, 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 that goes along with it to get the relevant funding. We have always successfully advocated for our clients. Otherwise, we would not be in business.

This is also why we’re 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, our NDIS Support Coordinator, and I will put a link to an interview with Amanda in the written version of this blog below the video. We’re also providing TAC case management and WorkSafe case management in Victoria with Lucy McCotter.

If you are 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 can 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, we’re currently hiring for jobs for critical care nurses in the home 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 though, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients do want the same staff coming over and over again because they are so vulnerable and so special, and that’s why we need regular staff. So, if you are looking for agency work where you can come and go, this won’t 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 relationships with us and with our clients, otherwise, it’s not going to work.

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 ICU and 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, ED beds, and in most cases, you won’t even pay for it. Even if you do pay for it, it’s much more cost-effective than what you’re paying in ICU and ED for.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, respiratory wards, etc., please reach out to us as well. We can help you there 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 and with consulting.

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 leave your comments below, what you want to see next, what you think about today’s topic, and what 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.

Take care for now.