Hi it’s Patrik Hutzel from INTENSIVECAREATHOME.COM.AU where we help long-term ventilated Adults& Children with Tracheostomy to improve their Quality of life and where we also help hospitals and Intensive Care Units to save money and resources, whilst providing Quality Care!

In last week’s blog I wrote about a real world example “Going home from Intensive Care after a stroke, a real world example”. You can read, watch or listen to last week’s update by clicking on the link here.

In this week’s blog I want to evaluate “When should you consider home care for ventilated Adults or Children with Tracheostomy?”

Given that Intensive Home Care is a relatively new concept in Australia, the question inevitably arises when Intensive Care Units should consider using external services like INTENSIVE CARE AT HOME?

It’s a great question to ask and sooner or later every Intensive Care Unit has Adults or Children who fit the criteria for Intensive Home Care services.

For those of you who haven’t heard about Intensive Home Care services, it’s a service that is an extension to Intensive Care and it provides care in the home for long-term ventilated Adults and Children with Tracheostomy as a genuine alternative to a long-term stay in Intensive Care!

As a rule of thumb, most Adults or Children who fit the criteria for Intensive Home Care services are medically stable, but they are ventilator dependent with Tracheostomy. They don’t tend to be inotrope dependent, however the ventilator dependency is keeping them in Intensive Care!
There are a few scenarios in Intensive Care that happen over and over again, where Intensive Home Care Nursing provides a win-win situation for all stakeholders:

• Chronic Respiratory failure
• Diseases of Impaired Respiratory Control
• Central alveolar hypoventilation
• Guillain–Barrè syndrome
• Neuromuscular Diseases
• Spinal cord injury
• Nerve or muscular disease, eg, muscular dystrophy, amyotrophic lateral sclerosis
• Diaphragm paralysis
• Chest Wall Diseases
• Kyphoscoliosis
• Thoracoplasty (eg, TB )
• Pulmonary Diseases
• COPD
• Cystic fibrosis
• Bronchiectasis
• Single or bilateral Lung transplant and ventilator dependency

The methods of delivering Mechanical Home Ventilation can be divided into two major categories:

1) Invasive positive-pressure ventilation via Tracheostomy (TPPV)
2) Non-invasive ventilation (NIV) or mask ventilation, of which there are several varieties

Full-time or part-time ventilation can be accomplished with either method of ventilation. Although equipment varies somewhat between the two methods, characteristics of Client, family, and the quality of the nursing service that lead to successful home ventilation are similar.

Any of the situations above can then be divided into further categories such as

1) Ongoing or life long ventilator dependency where an optimisation of the Quality of Life for the Client would be a major focus. I.e. what resources are necessary to provide the Client and their Family with a better Quality of life and what opportunities and possibilities are available in a home care environment with the right support structure in form of an accredited Intensive Home Care nursing service

2) A weaning situation, where a long-term ventilated Adult or Child with Tracheostomy is in a long-term weaning situation and has a limited Quality of life in an Intensive Care environment. The Client therefore is much better off at home, where Quality of life and weaning can be achieved in a Client and Family friendly environment.

3) An end of life situation, where a (long) term ventilated Adult or Child with Tracheostomy approaches their end of life in Intensive Care. This on occasion can happen over many weeks and sometimes many months. In order to have Quality of end of life, an end of life situation in a home care environment tends to have all the ingredients that give the Client and their Families more peace of mind. Most surveys also suggest that 75% of Australians want to die at home if given a choice, however yet than 20% do.

You can also find more information here at the Mechanical Home Ventilation Guidelines https://intensivecareathome.com/mechanical-home-ventilation-guidelines/

A competent, passionate and highly skilled nursing workforce is the key to success!

It goes without saying that in all situations a competent, passionate and highly skilled workforce with Critical Care trained Nursing staff are providing the care to those Clients and their Families and are the key to success.

It also goes without saying that in any of the situations, your Intensive Care Units would also be having the ability to free up your Intensive Care beds that tend to be blocked by long-term ventilated Adults and Children. Besides having the advantage of freeing up an expensive bed in Intensive Care, Intensive Home Care tends to also be more cost effective, compared to a $ 5,000 per day ICU bed.

The alternative? An expensive and burdensome long term stay in Intensive Care maybe even a lost life in Intensive Care due to depression and a fading will to live…
It also frees up Families of those Clients and they don’t have to spend day and night in Intensive Care…

What are your thoughts? Do you think that Home care for long-term ventilated Adults& Children with Tracheostomy provides a better alternative to a long-term stay in Intensive Care? Leave your comments here on the blog or send me an email to [email protected]

Please also note that INTENSIVE CARE AT HOME has been selected as a preferred provider for Queensland Health Services as part of the recent “HOSPITAL IN THE HOME” tender.

You can also contact me on 041 094 2230 if you want to know more about how we can help you, your Intensive Care Unit and your Patients and Families.

Thank you for tuning into this week’s blog.

This is Patrik Hutzel from INTENSIVECAREATHOME.COM.AU and I’ll see you again in another update next week.