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Can My Ventilated Dad in ICU with MND (Motor Neurone Disease) Get a Tracheostomy and Go Home with INTENSIVE CARE AT HOME?
Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies and where we also provide tailor-made solutions for hospitals and intensive care units whilst providing quality care services for long-term ventilated adults and children with tracheostomies, also otherwise medically complex adults and children at home, including Home BIPAP (bilevel positive airway pressure), Home CPAP (continuous positive airway pressure), home tracheostomy care when adults and children are not ventilated. We also provide Home TPN (total parenteral nutrition) which is IV nutrition. We also provide IV potassium, IV magnesium in children at home, as well as IV antibiotics at home. We also provide port management, central line management, PICC (peripherally inserted central catheter) line management, Hickman’s line management, as well as palliative care services at home. It also includes ventilation weaning at home.
We have also provided an emergency department bypass service for the Western Sydney Local Area Health District and where we send our critical care nurses into the home to prevent emergency department admissions.
Now, today I have a question from Jerry, and Jerry says,
“Hi Patrik,
My dad is 68 years old, and he has been in ICU for eight days. Now, he has been having motor neurone disease for the last 10 months. He now developed sepsis and was hospitalized for the second time after four months. He has a PEG (Percutaneous Endoscopic Gastrostomy) tube, but his large intestine was not getting enough oxygen and he had an internal ischemia. Part of his large intestine was removed. They did a colostomy procedure on him. He was in a medically induced coma for the last four days during these procedures. They did a CT scan of the abdomen to discover why there is not enough oxygen.
Because of the MND (Motor Neurone Disease), he can’t talk, walk, or swallow. His breathing and oxygen were not at the safest number, so he was intubated on a ventilator again yesterday. He’s on 55% to 60% FiO2 (Fraction of Inspired Oxygen) or oxygen on the ventilator. The GI doctor wants to strongly recommend taking him off life support. It’s only been a day so far. He is intubated with no sedation. The nurses are saying he is weak but still he’s tolerating the intubation with just pain medications, and he’s drowsy and opens his eyes.
What can we do?”
Well, that’s a great question, Jerry. We have seen this situation many times. So, for example, one solution for your dad might be a tracheostomy and then go home with Intensive Care at Home. So, let me elaborate on this in more detail.
We are currently looking after clients at home with MND (motor neurone disease) that are ventilated and have a tracheostomy, and that is their choice. They do want to live. Some MND clients or MND patients for that matter, they get diagnosed with MND and then they don’t get a tracheostomy. Although they don’t want a tracheostomy, they go on BIPAP and eventually BIPAP can be removed, and they can pass away if that’s what they want. But many MND clients don’t want that, they want to live, and they want the tracheostomy, and they want to spend quality time with their family, which is an option for your dad in this situation as well.
Again, some hospitals, they don’t even know that the Intensive Care at Home exists, and that Intensive Care at Home is definitely an option for MND clients who want to have a tracheostomy and want to be ventilated. Some of our clients that have been at home or are at home on MND, they report to have a good quality of life and like I said, they do want to live. So, the notion from the hospital taking off life support, I believe comes from a place of not being informed what is available in the community, if that is what your dad wants.
Now, the question here is, does your dad have an advanced care plan? It would be very important to find out if your dad has an advanced care plan that states what he wants. An advanced care plan is a legally binding document and if your dad wants to have a tracheostomy and the ventilator, then he should be allowed to have that. It is very unlikely in this situation that your dad will come off the ventilator and the breathing tube. It is very unlikely I would say, given the progressive nature of MND. It is also very likely that if he does get extubated and put on BIPAP, that he will end up with an aspiration pneumonia. Many MND patients that end up with a tracheostomy actually end up there because they are on BIPAP, and they then have an aspiration pneumonia and therefore they get intubated like your dad did in this situation.
And now it’s crucial to take the right next step, that is the next step what your dad and your family wants. If your dad does not want to continue treatment, then that is his choice and that should be respected. If your dad does want to continue treatment and does want to have a tracheostomy, then that is what should be respected as well.
There is a solution on the other end and that is where Intensive Care at Home comes in with home care, and there is a model in there because an intensive care bed costs around $5000 to $6000 per bed day. Intensive Care at Home costs around 50% of that, so there’s a business model in there, there’s economical sense in what we are providing.
There’s also that hospitals need the ICU bed. The ICU bed is the most highly sought-after bed in a hospital. ICU staff, doctors, nurses, physios are some of the most highly sought-after people within the healthcare industry. So, it makes perfect sense that Intensive Care at Home is a viable option for everyone. It’s a win-win situation. We improve the quality of life for patients and their families. We also improve the economics of health funding agencies, and we improve the bed standards of intensive care units because intensive care beds are so highly sought-after.
I hope that answers your question, Jerry, what to do next with your dad.
With Intensive Care at Home, we are currently operating all around Australia in all major capital cities, as well as regional and rural areas. We are a NDIS (National Disability Insurance Scheme) approved service provider all around Australia. We are TAC (Transport Accident Commission) service provider and WorkSafe approved service provider in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme) in Queensland, as well as DVA (Department of Veteran Affairs) approved service provider all around Australia. We have also received funding through public hospitals, departments of health as well as private health funds. So, reach out to us if you need help.
You can reach out to us at intensivecareathome.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].
Like I mentioned, we are sending our critical care nurses into the home for predominantly long-term ventilation and tracheostomy but also, we send them into the home to keep emergency departments empty and for patients to bypass emergency departments. Like I said, we have done that successfully for the Western Sydney Local Area Health District and we have bypass some of their patients out of ED.
Now, if you are in intensive care or if you have a family member in intensive care, and you’re watching this, I encourage you to reach out to us if you are thinking of going home for the situations that I mentioned in the beginning of the video.
If you are a NDIS Support Coordinator and you’re looking for nursing care for your participants or for more funding because you don’t know how to advocate for nursing care, please reach out to us as well. We can also help you with a specialist NDIS nursing assessment.
We are also providing Level 2 and Level 3 NDIS Support Coordination in-house. So, if you need to get on the NDIS or if you need Level 2 and Level 3 NDIS Support Coordinator, please reach out to us as well. We can help you with that.
If you are a critical care nurse and you’re looking for a career change, we want to hear from you as well. If you have worked for a minimum of two years in critical care ICU, pediatric ICU or ED (emergency department) and if you ideally have completed a postgraduate critical care qualification, we currently have jobs in Melbourne, Sydney, Brisbane, Albury, Wodonga in Bendigo, which is in Country Victoria, as well as in Warragul in Country Victoria. We want to hear from you.
We are looking for intensive care nurses or critical care nurses that want to complement our team, people who are team players and people who are looking for regular work. We are a service provider with a tailor-made solution for our clients and we are not an agency. We actually pride ourselves to providing this tailor-made solution to our clients. So, if you’re looking for agency work and you want to come and go, please do not apply, only apply if you’re serious. If you want to make a difference to our client’s life, if you want regular work, if you are reliable and that includes working with our clients on a regular basis.
If you are an intensive care specialist, we are currently expanding our medical team as well. We want to hear from you.
If you’re an intensive care specialist and if you have bed blocks in your ICU, I encourage you to reach out to us as well. We can help you eliminate your bed blocks, but more importantly, we can improve the quality of life and in some instances, quality of end of life for your patients and their families and you won’t even pay for it.
If you’re a hospital executive watching this, we also want to hear from you because again, we can help you eliminate bed blocks in ICU and ED.
If you are in the U.S. or in the U.K. and you need help, please reach out to us as well. We can help you there privately.
Once again, our website is intensivecareathome.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].
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Thanks for watching.
This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.
Take care for now.