My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies, tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure), non-invasive ventilation, tracheostomy care without ventilation, home ventilation weaning, home cough assist management, home intravenous (IV) potassium, home IV magnesium, home TPN (Total Parenteral Nutrition), home IV fluids, home IV antibiotic infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, port management at home, suprapubic catheter (SPC), indwelling catheter (IDC), nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) tube and PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home as well as palliative care management at home.

 

In this week’s blog post and video, I’m answering yet another great question from one of our readers and viewers. Today’s question comes from Candice, who asks:

 

Hi Patrik, 

 

My question is related to a patient with high spinal cord injury requiring 24/7 ventilation on SIMV (synchronized intermittent mandatory ventilation) mode and tracheostomy triggered at nights. I’m trying to get an understanding of the specifics a home ventilator would need in order to provide this invasive positive pressure tracheostomy support. I’m also trying to understand what equipment is needed at home and how we can engage Intensive Care at Home.

 

From Candice.

 

Thank you so much for your question, Candice. This is exactly the kind of clinical question we love to answer because it helps not just you, but the many families, nurses, doctors, allied health professionals, and case managers who are trying to navigate what home-based intensive care looks like for a high-level spinal cord injury patient. Let me break this down for you in a very practical way.

 

What Is a High Spinal Cord Injury and Why Does It Require 24/7 Ventilation?

A high spinal cord injury, typically at or above the C3/C4 level, which obviously includes C2 and C1 levels, affects the phrenic nerve, which is the nerve that drives the diaphragm to breathe. When the diaphragm is paralyzed or significantly impaired, a patient cannot sustain independent breathing and will require full-time or near full-time mechanical ventilation support with a tracheostomy.

 

These patients are among the most clinically complex individuals we care for in the community with Intensive Care at Home. They are genuinely intensive care level patients living outside of an ICU, and that is exactly why the right 24/7 intensive care nursing service, the right equipment, the right clinical governance, as well as the right clinical mindset matters enormously.

 

What Is SIMV Mode and Why Is It Used for High Spinal Cord Injury Patients?

SIMV stands for synchronized intermittent mandatory ventilation. It is a ventilator mode that delivers a set number of mandatory breaths per minute at a set tidal volume, while also allowing the patient to take spontaneous breaths in between the mandatory breaths.

 

For a high spinal cord injury patient who has some residual or partial respiratory drive, particularly at night when respiratory effort can decrease further, SIMV provides an important safety net. The ventilator guarantees a minimum minute volume, and if the patient triggers a breath spontaneously, the ventilator supports or allows that breath.

 

Candice mentions the SIMV is triggered at nights, which tells me this patient likely has some level of respiratory reserve during the day, possibly supported by a different mode or with periods of spontaneous breathing, but requires the full mandatory support of SIMV during sleep when drive and muscle tone naturally diminishes. This is a common clinical picture in high spinal cord injury patients, and it is entirely manageable in the home environment with the right setup.

 

What Ventilator Specifications Are Required for 24/7 Invasive SIMV Ventilation via Tracheostomy at Home?

When you go to our website and look at the evidence-based Mechanical Home Ventilation Guidelines, they are very clear on the minimum requirements for home ventilators in life-supporting applications, and they align with international ISO standards.

 

Here is what the home ventilator needs to be capable of for a high spinal cord injury patient on 24/7 SIMV via tracheostomy.

 

SIMV mode availability: the ventilator must support SIMV with pressure support for spontaneous breaths. All of our clients at home have sophisticated home ventilators that offer virtually all modes available compared to an ICU ventilator in a hospital.

 

Needs adjustable respiratory rate, tidal volume or pressure control, and inspiratory/expiratory ratio.

 

Pressure support capability for spontaneous breaths in SIMV.

 

PEEP (positive end-expiratory pressure) capability to keep the alveoli open at the end of expiration.

 

Comprehensive alarms: high pressure, low pressure, apnea, disconnect, and power failure alarms are non-negotiable.

 

Internal battery backup: essential for life-supporting ventilation.

 

External battery pack with a minimum 8 to 10 hours capacity required when ventilation exceeds 16 hours per day.

 

If ventilation exceeds 16 hours per day, a second identical backup ventilator must be provided. This is a guideline requirement, not optional.

 

Heated humidification system for tracheostomy ventilation: active humidification is required to prevent secretion retention and mucous plugging.

 

Compatibility with heated wire circuits suitable for tracheostomy use.

 

For this patient specifically, given that they require 24/7 ventilation, a backup ventilator is mandatory. This is non-negotiable for patient safety.

 

Common home ventilators used for this level of care include devices such as the Astral 150 from ResMed and the Trilogy from Philips Respironics. Your respiratory physician or home ventilation team will determine the most appropriate device for the individual patient’s needs.

 

What Other Equipment Is Needed at Home for a High Spinal Cord Injury Patient on 24/7 Tracheostomy Ventilation?

The home setup for a high spinal cord injury patient on 24/7 invasive SIMV ventilation goes well beyond just the ventilator. Here’s what’s required.

 

Primary home ventilator with SIMV and all required capability. Identical backup ventilator — mandatory for 24/7 ventilated patients. Heated humidification system, such as the Fisher & Paykel MR850 or equivalent. Heated wire ventilator circuits. Ventilator stand or mount. External battery packs and charging systems. Spare circuits, filters, and other consumables such as suction catheters, Swedish noses or heat and moisture exchanger (HME) filters.

 

Let’s now look at Tracheostomy Equipment:

Appropriate tracheostomy tubes, cuffed with inner cannula, sizes and type determined by a respiratory physician or ear, nose and throat (ENT) specialist. Spare tracheostomy tubes, same size and one size smaller, always at the bedside or in an emergency bag if out in the community. Tracheostomy care kit: dressings, tapes, securing devices. Suction machine, high performance, battery supplied, with appropriate suction catheters. Manual resuscitation bag, such as a Laerdal bag valve mask with tracheostomy adapter, and PEEP valve, always at the bedside, or with the patient if in the community. Spare inner cannulas. Saline for tracheostomy care and for nebulizers. Tracheostomy tapes. HME filters or Swedish noses if a patient can breathe spontaneously.

 

Monitoring Equipment

Pulse oximetry: continuous SpO2 monitoring is standard for 24/7 ventilated patients. Capnography, end-tidal CO2 monitoring, increasingly standard for home ventilation at this level. Apnea monitor if required. Supplemental oxygen supply, cylinder and/or concentrator. Even if the patient is not currently oxygen dependent, it must be available for emergencies.

 

Communication and Emergency Equipment

Call bell or communication device accessible to the patient. Emergency response plan and emergency contact list. Written emergency protocol for tube displacement, circuit disconnection, and power failure.

 

As much as we are preparing for emergencies, prevention is better than cure. We are always wanting to prevent emergencies. We always ask our nurses: what do we need to do today to prevent emergencies tomorrow? That’s a much better question to ask, but of course we want to be prepared for any emergencies as well.

 

Power Redundancy

Uninterruptible power supply (UPS) or backup generators for life-supporting ventilation. Power failure planning is essential. Notification to the electricity distributor of a life support patient at the property. This is a legal requirement in most countries.

 

What Are the Nursing Requirements for 24/7 Invasive Home Ventilation?

This is where the clinical governance piece becomes critically important. As our evidence-based Mechanical Home Ventilation Guidelines make very clear, any service delivery without critical care trained nurses 24/7 puts the ventilated adult or child at significant risk of death. Service delivery that doesn’t meet the minimum staffing qualifications is outside of the gold standard and evidence-based guidelines.

 

For a high spinal cord injury patient on 24/7 SIMV ventilation with a tracheostomy, the minimum nursing requirement is 24/7 critical care registered nurses who have completed postgraduate critical care qualifications and who have hands-on clinical experience managing ventilated patients, tracheostomies, and the associated complications that may occur. Prevention is better than cure, we want to prevent them.

 

This is not a role for general, community, or hospital nurses, let alone for personal care workers or disability support workers. That would be like flying the airplane with the cabin crew instead of the pilot. The acuity of this patient group mirrors that of an ICU patient and the nursing skill set must match accordingly to keep the client safe at all times.

 

Candice, in this situation, you need 1-to-1 critical care nursing 24 hours a day, 7 days a week, 365 days of the year. You need at least 1 support worker for manual handling or for clinical procedures such as tracheostomy changes, 2 nurses can manage this at handover time. A clinical governance structure including care plans, emergency protocols, and competency frameworks. Nurse managers, nurse educators, and regular clinical reviews.

 

This is the very clinical governance we have in place at Intensive Care at Home.

 

How Can You Engage Intensive Care at Home?

I’m so glad Candice asked this question because engaging the right service early, ideally while the patient is still in hospital and in ICU, makes the transition to home significantly smoother for the patient, the family, and the hospital team.

 

Here’s how you can engage us. Call us directly. Our contact numbers are listed on the website at intensivecareathome.com. Email us at [email protected]. Make an appointment via our scheduling page at intensivecareathome.com. Once you reach out, we will conduct an initial assessment free of charge of the patient’s clinical needs, review the home environment, liaise with the hospital and ICU team, respiratory physician, and develop an individualized home care plan. We operate all around Australia.

 

Why Accreditation Matters When Choosing a Home Ventilation Service?

 

Intensive Care at Home is the only Intensive Care at Home nursing service in Australia that is third-party accredited specifically for Intensive Care at Home nursing. You can read more about our accreditation and quality framework at intensivecareathome.com/accreditation-quality.

 

We have operated since 2012 and we are Australia’s first and only fully accredited Intensive Care at Home nursing provider. There is no other provider in Australia that has achieved third-party accreditation for the intellectual property we have built from scratch here with Intensive Care at Home, and we are absolutely committed to full certification, which we achieved again in December 2025, a result that reflects our absolute commitment to clinical governance, safety, and quality.

 

When we are placing a 24/7 ventilator-dependent patient with tracheostomy in a home care environment, accreditation is not a nice-to-have. It is the very foundation of safe, evidence-based care. It means there are systems, policies, competency frameworks, clinical governance structures, and accountability mechanisms in place, not just goodwill and good intentions.

 

No other Intensive Care at Home nursing service in Australia holds this level of independent third-party accreditation for intensive care nursing in the home, which is why we are the only provider that built the intellectual property to make this happen. And that also enables us to employ the best critical care nurses in the country. We are employing hundreds of years of intensive care nursing experience combined in the community. No other service provider brings a higher skill level in the community than Intensive Care at Home.

 

Let’s also look at NDIS (National Disability insurance Scheme) Funding for High Spinal Cord Injury Patients on 24/7 Home Ventilation.

 

For patients in Australia, NDIS funding is often a primary funding pathway for high spinal cord injury patients requiring 24/7 intensive care nursing support at home. Intensive Care at Home is an approved NDIS provider, and we provide Level 2 and Level 3 specialist support coordination to assist clients and families in navigating the NDIS process for clinically complex participants. We are also TAC-approved and we are providing TAC (Transport Accident Commission) case management.

 

NDIS funding, TAC funding, DVA (Department of Veteran Affairs) funding, private health funding, or Department of Health funding for a participant requiring 24/7 ventilation and nursing at this level is significant, and the planning process requires clinical expertise to ensure the plan adequately reflects the participant’s clinical support needs. Getting this right from the start matters. Underfunded plans create gaps in care that put the patient’s life and safety at risk.

 

If you are navigating NDIS, TAC, DVA, private health funds, Department of Health, or any other funding body for a high spinal cord injury patient, we strongly encourage you to reach out to us early. Our specialist support coordination team, TAC case managers, and experienced clinical team and advocates have deep clinical knowledge of what high-acuity home care actually requires, and we will advocate for an appropriate and clinically defensible plan.

 

 

To summarize the key points for Candice and everyone reading or watching this:

 

High spinal cord injury patients, C3/C4 and above, which means C2 and C1 as well, typically require 24/7 invasive mechanical ventilation with tracheostomy. SIMV is an appropriate mode, providing mandatory breath delivery with patient-triggered support.

 

The home ventilator must be life-supporting capable with internal and external battery backup, alarms, and humidification. A backup ventilator is mandatory for 24/7 ventilated patients.

 

Equipment requirements at home go well beyond the ventilator, suction, monitoring, oxygen, emergency protocols, and power redundancy are all essential.

 

Only critical care registered nurses should provide nursing care at this acuity level.

 

Intensive Care at Home is Australia’s only third-party accredited Intensive Care at Home nursing provider.

 

NDIS funding is available and we provide Level 2 and Level 3 NDIS specialist support coordination. If you are TAC, NIISQ (National Injury Insurance Scheme, Queensland), icare New South Wales, DVA, private health fund, or Department of Health funded, or you think you can access funding, please reach out to us, we can help you with any funding body.

 

And if you’re a family member, nurse, doctor, allied health professional, case manager, NDIS support coordinator, or hospital discharge planner watching or reading this, please reach out to us at intensivecareathome.com. We would love to help you navigate this journey safely. Go to intensivecareathome.com and reach out to us today.

 

 

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.