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Hi it’s Patrik Hutzel from INTENSIVE CARE AT HOME where we provide tailor made solutions for long-term ventilated Adults & Children with Tracheostomies and where we also provide tailor made solutions for hospitals and Intensive Care Units whilst providing quality services for long-term ventilated patients and medically complex patients at home, including home TPN.

In last week’s blog, I talked about,

DAD HAS MOTOR NEURONE DISEASE & CAN’T COME OFF THE VENTILATOR IN ICU. CAN WE GET HIM HOME WITH INTENSIVE CARE AT HOME?

You can check out last week’s blog by clicking on the link below this video:

https://intensivecareathome.com/dad-has-motor-neurone-disease-cant-come-off-the-ventilator-in-icu-can-we-get-him-home-with-intensive-care-at-home/ 

In today’s blog post, I want to answer a question from one of our clients and the question today is 

How Long Can You Live with a Tracheostomy? Live stream!

Good morning. Good afternoon. Good evening, wherever you are. Welcome to another Intensive Care at Home livestream.

Today is all about tracheostomy, and today I want to answer a question and I want to deep dive into the question, “How long can you live with a tracheostomy?” It’s a question we get all the time, whether it’s at Intensive Care at Home or at Intensive Care Hotline. It’s a bread-and-butter question for us because we are dealing with so many clients that have a tracheostomy or are at a point where they may get a tracheostomy or want to decide whether they should get a tracheostomy and so forth. So, that’s the topic today, and I want to welcome you all.

Just a couple of housekeeping issues. If you want to ask any questions related to today’s topic, please type them into the chat pad. I’ll also give you the opportunity to dial live into the show if you want to at the end of today’s presentation, and hopefully we can get all of your questions answered.

Before I dive into today’s topic, you may also wonder what makes me qualified to talk about today’s topic, “How long can you live with a tracheostomy?” So, I’m a critical care nurse by background and I have worked in ICU/critical care for over 20 years in three different countries. Out of those 20 years in ICU, I have also worked for over five years as a nurse unit manager in intensive care. I have been consulting and advocating for families in intensive care all over the world since 2013 as part of my intensivecarehotline.com. And I also own and operate an Intensive Care at Home nursing service, Intensive Care at Home, where we provide intensive care nursing services at home for predominantly long-term ventilated adults and children with tracheostomy. Me and my team, we’re dealing with tracheostomies and tracheostomy clients and ventilation all day, every day with clients all around the world really. So, that’s a little bit about me.

If you find this video valuable today, I would also like you to share it with your friends and families, give it a thumbs up, subscribe to my YouTube channel so you can get regular updates for families in intensive care and for Intensive Care at Home.

As I said, please leave your comments below and I will answer your questions as we go along. Keep them on today’s topic, and if not, I will answer them at the end of today’s topic and today’s presentation.

Let’s dive right into it. How long can you live with a tracheostomy? As much as I would like to give you a number, as much as I would like to give you months, years, whatever it is, the answer is that it really depends, and I want to break down to you why it depends and what are the nuances, how long one can live with a tracheostomy?

Let’s just quickly look at the fundamentals of tracheostomy. When is a tracheostomy being done? Most of the time, a tracheostomy is a result of a patient in ICU, pediatrics or adults. And the inability of them to be weaned off a ventilator with a breathing tube and an endotracheal tube, that’s when patients end up with a tracheostomy. One of the most frequently asked questions that we get, and I’ve done videos about this and blog posts is, “How long can a patient stay on a breathing tube before needing a tracheostomy?” So, that’s basically the fundamentals of tracheostomy, but we’ve covered that in other videos and blog posts previously on our Intensive Care at Home blog, as well as our intensivecarehotline.com blog. So, that’s the fundamentals.

Other fundamentals are, for example, for patients with high spinal injuries, such as C1 or C2 spinal injuries, they need a tracheostomy because of their inability to breathe and cough from day one of their insult. That’s probably the exception to the rule but you can almost do a tracheostomy straight away, whereas with many other clients, you can wait and see whether a trial extubation will succeed. If it doesn’t succeed, then proceed to a tracheostomy.

Another situation where someone might need a tracheostomy is when an ENT surgeon perform a laryngectomy. They take out the larynx, often for throat cancer, and then a tracheostomy is needed as well.

What are other conditions that might lead to a tracheostomy and why? Other conditions that may lead to a tracheostomy are conditions such as motor neurone disease, Guillain-Barre, COPD (Chronic Obstructive Pulmonary Disease), cerebral palsy, TBI (Traumatic Brain Injury), anoxic brain injury, hypoxic brain injury, pneumonia, COVID pneumonia, COVID ARDS, or ARDS (Acute Respiratory Distress Syndrome) in general, stroke, and so forth.

Now, we’ve got our first question here and T.S. 1213 asks, “My brother suffered a cardiac arrest on June 23 and he’s still in a deep coma. Heart stopped for 37 minutes.” That is a question that I will an answer at the end when I went through the today’s presentation. I’m sorry. I want to, first of all, answer the question today, “How long can someone live with a tracheostomy?” That’s today’s topic, but I will answer your question after I’ve gone through today’s presentation.

Once someone has a tracheostomy, the goal should be to wean someone off the ventilator and off the tracheostomy. That should always be the goal. Can that always be achieved? No, it can’t always be achieved, which is when our service Intensive Care at Home comes in, where we can take patients home in their own environment where they can have intensive care treatment, intensive care therapy at home. The reality is that when someone needs a ventilator and a tracheostomy, whether it’s inside or outside of intensive care, they need intensive care nurses and not support workers, not general registered nurses. The reason I’m saying that is, if you have a look on our website at intensivecarehome.com, we publish the evidence-based Mechanical Home Ventilation Guidelines that clearly state that only intensive care nurses with a minimum of two years of ICU experience are safe to look after someone at home on a ventilator and/or a tracheostomy.

From experience, we have had clients that were at home, and we were only funded for doing night shifts, that was for tracheostomy and/or ventilation. And we warned the funding bodies at the time, the insurances, as well as the families, that as soon as we leave, the clients are not safe, and they could die from a medical emergency. Of course, that unfortunately became a reality that when we weren’t there with intensive care nurses that medical emergencies couldn’t be managed by families, by support workers or disability support workers, or even by a general registered nurse without ICU experience, and the clients inevitably passed away.

The bottom line is this; ventilation and tracheostomy does need an intensive care nurse 24 hours a day. Full stop. There’s no room for negotiation, and it’s evidence-based. It’s come out of 20 years of Intensive Care at Home nursing services, so you can have a look at that on our website.

Let’s just quickly look at types of tracheostomy tubes, cuffs and Passy-Muir valve used. The most commonly used tracheostomy tubes that I’ve come across is Portex, Shiley, and Bivona. They’re the most commonly used, and they’re brand names, most commonly used tracheostomies in the community in particular, but also in the ICU. Some of them do come within inner cannulas. Some of them don’t have inner cannulas. Some of them have a block that keeps the tracheostomy, and some of them are unblocked.

For someone that is ventilated, most of the time you need a blocked cannula so that the ventilation air doesn’t leak. Simple as that. If someone has an inner cannula, that’s most of the time a good thing, because you can change the inner canula multiple times a day. You can inspect for blockages. It’s more difficult to inspect for blockages if there’s no inner cannula, but it also depends on whether someone has a lot of secretions or whether they have minimal secretions. It depends on all of that, whether you need an inner cannula or not.

Other things that can be used, especially when it comes to neuromuscular diseases or spinal injuries and people have the inability to cough are things like a cough assist machine in the community, in particular. That works very well to clear secretions, prevent pneumonia, prevent atelectasis. That works really well, especially in the community, but in the ICU as well, but you just have more resources in ICU. But in the community, we recommend a cough assist machine, especially for ventilated patients.

Next, if someone can have time off the ventilator, they should be using a Passy-Muir valve, a speaking valve, assuming they can talk, their neurology is intact. That’s not always the case for patients that sustained a hypoxic brain injury, an anoxic brain injury, or a stroke, so you got to weigh up whether someone has the ability to speak with a Passy-Muir valve, depending on their condition, their diagnosis.

Next, when someone has a tracheostomy, they should be using a humidifier and saline nebulizers regularly. They need frequent suctioning. Frequent inner canula changes, if they have an inner canula. You should also deflate the cuff. If it’s a blocked cannula, you should also deflate the cuff and potentially deflate the cuff, and then do a suction to suction below the cuff. Tracheostomy dressings need to be changed at least twice a day, making sure the stoma is intact, no skin breakdown, needs a proper clean, manage infection risk. So, that needs to be done twice a day, at least. Sometimes, depending on the level of secretions, maybe three or more times a day. Again, needs the skill of an intensive care nurse who knows how to manage and protect as an unstable airway, because that’s what a tracheostomy is at the end of the day. It’s an unstable airway.

Then, my next point is emergency management. Well, emergency management is really important. Again, this is where it comes back to the skill of an intensive care nurse. You can’t just pick people off the street and “train them on emergency management of a tracheostomy”. If a tracheostomy can hardly be managed outside of intensive care, and it can’t be managed outside of intensive care. Again, we have evidence that patients died in the community, or even in hospitals as soon as they leave intensive care, because a tracheostomy emergency cannot be managed outside of intensive care safely. And again, keep coming back to our mechanical home ventilation guidelines that are linked below this video.

Again, for example here, in Intensive Care at Home, we do train our staff on emergency management multiple times a year, or at least once a year for every staff member so they know how to manage emergencies with our ventilated clients at home with tracheostomy.

Communication in ventilated or tracheostomy patients. Again, I mentioned, especially if someone doesn’t need the ventilator, 24 hours a day, can they talk with the Passy-Muir valve? Can they potentially even talk without a Passy-Muir valve and just with a Swedish nose or an HME filter? Sometimes, it’s possible as well. But if they want to talk, the cuff needs to be deflated. If they are unable to talk, you can use potentially a letter board or you can get them to write, if that’s possible at all. Again, it depends on their condition. It’s certainly not easy for someone with a tracheostomy to communicate. It’s also not easy for a caregiver to sometimes decipher what a patient or a client has to say.

Another option that’s getting more and more prominent now is definitely computer devices, of course. Some of those can be operated with eye gaze, and we have some clients that are paralyzed, but they can operate a computer with eye gaze, and they can communicate with a PC or with an iPad. It works really well, works really well. Okay.

So, I briefly spoke about what conditions may lead to a tracheostomy. The most common one, and also from a general point of view, is simply that patients in intensive care can’t be weaned off the ventilator within 10 to 14 days. When you take them out of the induced coma, they can’t wake up. They might be breathing against the ventilator. They might be too weak to be weaned off the ventilator, and that’s when they need a tracheostomy because that’s when you can stop sedation, get them out of the induced coma, get them more awake. But if they’re more awake, it’s difficult to tolerate a breathing tube or an endotracheal tube. And if they’re not ready to be extubated and have the breathing tube removed, that’s when they need a tracheostomy.

Again, just quickly recapping what conditions may lead to that. Conditions such as motor neurone disease, Guillain-Barre syndrome, COPD, cerebral palsy, traumatic brain injuries, and also anoxic brain injuries, and hypoxic brain injuries, for example. After cardio arrest, after stroke, but also several pneumonias, COVID pneumonia, COVID ARDS, but other forms of ARDS as well, and stroke.

Let me now give you some case studies to explain, “How long can people live on a tracheostomy?” We’ve looked after now so many patients in intensive care or outside of intensive care with Intensive Care at Home to give you a very good understanding of how long can someone live. One of our first clients we had in the community was a 69-year-old lady who was in a car accident with her husband. Her husband survived at the time, didn’t take any injuries or harm from the accident. But the lady ended up in ICU with multi-trauma and she ended up with a tracheostomy. She was also undergoing chemotherapy at the time for breast cancer, and she could leave intensive care eventually being weaned off the ventilator just with a tracheostomy. She had the inability to swallow, which is why she needed a tracheostomy, but she wasn’t ventilated.

Clearly the goal was for her, because she had chemotherapy as well, the goal was clearly to let her spend time at home with her family as much as possible and it was a palliative care situation. We were looking after this lovely, lovely lady and her family for about 12 months before she passed away at home. Bear in mind, it was a fairly complex situation from a medical point of view with multiple trauma, as well as the tracheostomy and the chemotherapy that she had and the breast cancer. We kept her at home for as much as possible and provided the tracheostomy care at home, and then she passed away after about 12 months.

Other clients, another client we had in the past is a 35-year-old man who sustained a C1 spinal injury. C1 means a high spinal injury around the neck, where he’s been paralyzed from the neck down. He had the injury when he was about six years old as part of an accident, motor vehicle accident that he was in. He’s otherwise fit and healthy and he’s lived for decades, and he could live for a few more decades on a ventilator with a tracheostomy, as long as he has intensive care nurses, 24 hours a day.

Really, it’s not a one size fits all. A tracheostomy might have different goals for different people. For some people it might be to spend another few weeks before they pass away, and for some people it could mean decades.

Let’s go through a few more examples. We currently have two motor neurone disease clients, MND client in the community that are both ventilated with the tracheostomy. What happens with motor neurone disease, it’s a progressive disease where patients with that disease often end up initially on BIPAP, cough assist. And then eventually, the BIPAP is no longer enough because similar to a quadriplegic, after a spinal injury, they lose all ability to be mobile and they lose their ability to breathe completely. So, that’s when they need a tracheostomy. Again, with services like Intensive Care at Home, life can be prolonged, and patients can be looked after at home and have the quality of life at home. But both of those clients with motor neurone disease, they both are in their mid-40s, and they have young families. The choice for those clients was either not to do a tracheostomy and to die or to do a tracheostomy, go home with Intensive Care at Home, have 24 hours intensive care nursing, and then spend time with their families. Isn’t that a good option?

How long will they live? I don’t have a crystal ball. As long as possible. Again, with 24-hour intensive care nursing at home, it’s much safer than with support workers. Support workers, I can’t draw that comparison often enough. If you let support workers or even general nurses without ICU experience look after tracheostomy and ventilation in the home, that’s like flying the airplane with a cabin crew and not with a pilot. It needs specialized training. It requires years of ICU experience, to safely and competently manage tracheostomies at home or in the community.

Other examples are after a stroke, patients might need a tracheostomy because they can’t swallow. They may be able to function without a ventilator, but because their neurology is no longer intact, they might not be able to swallow or might not be able to cough. That’s when they need a tracheostomy. If they are unable to swallow and unable to cough, chances are that their saliva goes in the wrong place, i.e., into the lungs, and then patients end up with a tracheostomy.

Let’s just quickly take a quick break then let’s just answer your question to T.S. 1213, “My brother suffered a cardiac arrest on June 23 and he’s still in a deep coma. Heart stopped for 37 minutes. He’s on a tracheostomy now and he has a pneumonia now.” Why is he still in a coma? Is he still on sedation? Or why is he in a coma? Or did he sustain a hypoxic brain injury from the cardiac arrest? The more details you can give me, the better chances I can answer your question. So, Let’s carry on while I’m waiting for your answer. Let’s carry on with some other case studies.

We have two clients with cerebral palsy that have a tracheostomy and are at home on a ventilator. Again, how long does a client with cerebral palsy live and how long can they live with a tracheostomy? One of them has lived with a tracheostomy for about 10 years. As long as we can look after him safely, there’s no reason why he can’t continue to live. Bear in mind, cerebral palsy, and motor neurone disease, they are progressive diseases. It’s hard to say what the life expectancy is. A lot of it will depend on how successful we are to keep them out of ICU, because you don’t want them in ICU surrounded by all other bugs and COVID and all other bacteria and viruses, so you need to keep them out ICU. That’s often half of the battle.

T.S. 1213, you’re saying, “He’s on no sedation.” Why is he not waking up then? Is it because of a hypoxic brain injury as part of the cardiac arrest?

Okay, while I’m waiting for your answer, another client that we looked after at home is a young lady. She was 36 years of age, and she had a condition like dystonia, muscle weakness. She had Tonic-Clonic seizures, subglottic stenosis, Graves’ disease, grey matter heterotopia. A very complex client to look after at home, and she was at home for about two years before she passed away. Again, it’s not a one size fits all. A lot of it also depends a little bit on location as well. For example, if clients want to go home to a rural or remote area, it’s difficult to find staff there at times. Without 24-hour nursing care, it’s much more difficult to keep patients alive. Let’s call it for what it is. You need 24-hour nursing care with the intensive care nurses if you want to stay out of ICU, predictably. Predictably.

We’ve had a few examples now and I’ll go through more examples in a minute how long can people live? Again, it depends. I’ll also come to some examples in a minute when patients can be decannulated from a tracheostomy. I’ll come to that in a minute.

I just want to quickly keep going back to T.S. 1213, who says, “No sedation. The doctor stopped sedation. He has swelling in the brain. Doctor said he won’t give up. Do we have hope?” Then you’re saying, “Yes, it’s hypoxic brain injury. Only the brain stem is still okay.” Are you familiar with the Glasgow Coma Scale? If you are familiar with the Glasgow Coma Scale, can you tell me what his Glasgow Coma Scale is? Look, you should never give up, but I would need to know more. Would probably need to look at medical records, either talk to the doctors. It’s not enough information at the moment for me to say whether he’ll wake up or he won’t wake up. It’s not enough information. It would be very helpful if as a next step you could give me his Glasgow Coma Scale. While I keep going with the presentation, you could look up Glasgow Coma Scale on Google, and then give me the number, because it’s a fairly straightforward assessment tool. You can work it out.

Going back to some other examples and other case studies, I also want to talk about, “When can patients actually be decannulated and have the tracheostomy removed?” Great question to ask. Part of the services that we have provided with Intensive Care at Home is, for example, some toddlers, especially some premature babies that were born at 26, 30 weeks ended up in NICU in the neonatal ICU. Had lung disease to begin with, and ended up on prolonged ventilation with a tracheostomy, ended up going home after about 12 to 18 months of their lives, going home with the ventilator, going home with the tracheostomy. Slowly weaned them off the ventilator, and then eventually as their lungs were developing, as part of being a toddler, we were able to decannulate them. How good is that? Very successful decannulation there.

It’s probably more difficult with adults, especially with the conditions that I just mentioned, motor neurone disease, spinal injuries, COPD, cerebral palsy, traumatic brain injuries, pneumonia, COVID, and strokes. A lot of patients with pneumonia can be decannulated, and it’s temporarily the same with COVID pneumonia. A lot of those patients have been decannulated. But especially when it comes to neurological conditions that can’t be reversed, it’s very difficult to get a patient decannulated.

Now, let’s look at some other examples in terms of how long can someone live on a tracheostomy? Before I go to those other examples, T.S. 1213, yes. Have a look at the Glasgow Coma Scale, it’s very self-explanatory. As I said, as much as I appreciate your information, it gives me snapshots. It doesn’t give me the full picture. It would be good if you could reach out to me at [email protected], or simply call me on one of the numbers on the top of the website to give me more information. I need to understand the full picture. What medications is your brother on? What are blood results? It’s like piecing together a puzzle. Intensive care is such a complex area. I couldn’t be talking here for an hour if I didn’t have worked in the environment for over 20 years, but I need to understand the full picture.

Okay. Let’s go back to some other examples. We had a client at home with a tracheostomy, a child, who had a tracheoesophageal fistula. Basically, there was a connection between the larynx and the esophagus. Very complex airway, or what’s been considered a very complex and difficult airway. Unfortunately, the child was also prone to bleeds. Unfortunately, the child passed away when he was about five years of age. Very sad situation there, but problem was also that there was no 24-hour nursing care funded and we had warned the insurances at the time that without 24-hour nursing care, this child is at risk of dying when we are not there, because we were only doing the night shifts, and unfortunately, the child, like we predicted passed away during the day because the medical emergency couldn’t be managed by the people that were there who were not critically care trained. Very sad situation.

Again, it keeps going back to why we provide evidence-based care, and evidence-based care means in a home care environment for Intensive Care at Home, to exclusively work with critical care nurses with more than two years ICU experience. That’s what we do at Intensive Care at Home. We employ hundreds of years of intensive care nursing experience in the community. That’s a great thing. We have an amazing team working for us and they keep our clients safe.

Other examples are that we had a client, a young lady a while ago. She had a brain tumor way back when she was a child that operated on, but then ended up on BIPAP as part of some side effects from the surgery. Ended up on BIPAP with a tracheostomy, then ended up with some abdominal sepsis and ended up in ICU. Ended up with a tracheostomy, went back home with our service, Intensive Care at Home, was ventilated overnight, had the tracheostomy, was spontaneously breathing during the day, and was due for a decannulation later in the year, that would’ve been around 2020. Why was she due for a decannulation? I need to explain that too. For some patients, a diaphragm pacer might work. What do I mean by that? A diaphragm pacer can actually stimulate some spontaneous breaths with some electrodes, with a pacer, similar to a heart pacemaker. This young lady was in the middle of getting a two-stage operation done to have a pacemaker inserted with a goal of having the tracheostomy removed once the pacemaker was inserted and functional.

Unfortunately, similar to the other example that I gave you, we were only funded for the night shifts. There were no ICU nurses during the day funded but needed. Again, similar to the other example that I gave you that the client passed away during the day because the medical emergency couldn’t be managed by family or by support workers. Again, it keeps coming back to the Mechanical Home Ventilation Guidelines. Clearly evidence-based. You need the intensive care nurses 24 hours a day, and I also appeal here to the NDIS (National Disability Insurance Scheme), which is the funding body in Australia.

Most of our clients are funded through the NDIS, and I appeal to the NDIS to continue funding 24-hour nursing care that’s evidence-based for patients on mechanical ventilation with a tracheostomy. Even if patients are on non-invasive ventilation, such as by BIPAP or CPAP, they still need a critical care nurse, 24 hours a day, at home. The same if someone is not ventilated, “only has a tracheostomy”, they still need 24 hours critical care nurses at home. Just as I illustrated with my examples that medical emergencies with tracheostomies cannot be managed without critical care nurses, 24 hours a day. It’s clear and that comes out of 20, 25 years of Intensive Care at Home services now.

Other examples of clients are clients with an acquired brain injury, similar to hypoxic brain injury, or somewhat similar. When they go home, they often don’t need ventilation, but they need the tracheostomy, again, because they can’t cough, and they can’t swallow. And that obviously necessitates the use of a tracheostomy so that the airway remains stable and aspiration pneumonia is prevented. Those are all situations that need to be managed.

So, it really depends on what the condition is for a patient so that you can actually say how long a patient can live with a tracheostomy. It’s not a one size fits all. As you can see, it also doesn’t necessarily depend on age. You can see some children can get off the tracheostomy much quicker, and then some older folks might need it for the rest of their lives. There’s also some COPD or asthma clients in ICU that can’t be weaned off the ventilator even after they had a tracheostomy, and then they can go home with a tracheostomy, but then it’s often palliative care as well, where tracheostomy then is a vehicle to provide palliative care at home so people can approach end of life at home in an environment that is patient and family friendly and patient family centric.

That’s it in a nutshell, and I want to open the floor now for any other questions. I have a few more things to talk about, but in the meantime, please shoot away your questions. What do you want to know about this topic or any other topic? If you have a loved one in intensive care, shoot away your questions. We can now answer your questions around anything you want to know.

If you don’t want to type into the chat pad, you’re also welcome to call in live in the show now. I’ll give you the phone numbers. You should also see them below this video in the description box, but I’ll quickly mention them here. If you are in the U.S., you can call me on 415-915-009. That is again, U.S./ Canada, 415-915-0090. If you want to dial in now. U.K., 0118-324-3018. Again, U.K., 0118-324-3018. Australia, 041-094-2230. Again, Australia, 041-094-2230. If not, type the questions in the chat pad and I will get to them now.

Now that we’ve answered sort of the questions around, “How long someone can live?” I also want to quickly talk about, “What’s the quality of life for these people, for our clients?” I guess it really depends on what your view is on quality of life. It’s a very subjective view. If people say, “Oh, this person wouldn’t have any quality of life”, it’s not subjective because ask the people, ask the families, ask them what is acceptable for quality of life for you. Do you want to live with a tracheostomy? Can you accept your loved one living with a tracheostomy? What services do you need? What funding is available? There are all these questions that need to be answered, but quality of life, at the end of the day, is very subjective. There’s definitely no quality of life in intensive care. Hence, why we are providing Intensive Care at Home services?

Again, quality of life is very subjective. Most of our clients have quality of life. They’re going out during the day, or even on a ventilator with a tracheostomy because they have the intensive care nurse with them, 24 hours a day. Some of our kids that I was talking about earlier, they went to Kindy, they went to school. A tracheostomy shouldn’t stop people from living their lives, assuming they have the right services and support in place. It comes down to that. It all comes down to making it safe for patients and their families.

Then I talked about, “What is evidence-based?” Evidence-based for tracheostomies is clearly the Mechanical Home Ventilation Guidelines and I’ll put a link below this video in the description box so you can read them. Especially in the last two years, almost now two and a half years with COVID, imagine how vulnerable tracheostomy or ventilated clients are to go back into ICU if they’re at home already. You don’t want the clients to go back to an ICU that’s full of COVID. That’s not safe. That borders on insanity. That’s why, again, it’s so important to work with the home mechanical ventilation guidelines to keep people at home predictably. It would’ve been an issue before COVID going back to ICU from home, but now it’s an even bigger issue. That’s what we can help our clients to stay out of ICU, because their only alternative often is to go into ICU because they’re ventilated with the tracheostomy, and that’s what we are preventing here at Intensive Care at Home.

Also, I want to quickly talk about where do we provide the services? At the moment we provide the services predominantly in Australia, in Melbourne, Sydney, and Brisbane, but we can provide services in Australia in Adelaide and in Perth as well. You just need to reach out to us on our website at intensivecareathome.com. We can help you with the funding.

For our U.S. audience, we are not in the U.S. yet. Even though we have many inquiries, and we are talking to people in the U.S., but what we can do with our audience in the U.S., we can definitely advise you what to do if you have a loved one in intensive care. We’re also providing the consulting and advocacy for families in intensive care at intensivecarehotline.com.

The same in the U.K., we’re not in the U.K. yet. Again, we are providing the consulting and advocacy for families in intensive care through the intensivecarehotline.com, so you can have a look there.

What other questions? Are there no other questions at the moment? I hope that I clarified today, “How long can you live with a tracheostomy?” Shoot away your questions if you have them now. Call into the show now if you like. If not, I’ll slowly wrap up today’s presentation.

If you have a loved one in intensive care, you should go to intensivecarehotline.com. If you want to take your loved one home from intensive care, you should go to intensivecareathome.com.

If you have a loved one in intensive care, just call us on one of the numbers on the top of either of those websites, they’re the same numbers. Or you can just send us an email to [email protected] and we’ll get back to you.

If you need home care services because you have a tracheostomy or you have a loved one or you know someone with a tracheostomy that’s looking for care services, again, we can help you. Go to intensivecareathome.com.

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I do these YouTube lives regularly, usually on a Sunday morning Sydney, Melbourne time, 10:30 AM, which is currently at 8:30 PM Eastern Standard Time in the U.S., 5:30 PM Pacific Time in the U.S.

I can see there are still some people here. Shoot away your questions if you like. I would love to answer your questions. I would love to answer your questions and I’ll give it another minute and wait for your questions, or you can dial in live on the show if you like.

You know what I might do because I can see there’s still people here, I’m waiting for your questions. I’ll just quickly show you what a tracheostomy actually looks like. That’s a tracheostomy. You can see that. There’s the balloon there at the end that can be inflated to keep the tracheostomy in place, avoid aspiration, and also avoid a leak if a patient is ventilated. Some tracheostomies have an inner cannula. This is actually not inner cannula. This is just a guide wire, but inner cannula goes in and out like the guide wire. Again, the inner cannula is almost preventing a blockage, assuming it’s getting changed regularly, multiple times a day that prevents the tracheostomy from actually a blockage.

I’ll show you an inner cannula, what that looks like. This is an inner cannula, and the inner cannula goes in like that. Now, that doesn’t fit because it’s not the right size. But basically, let’s assume this is the in inner cannula, it’s not, but let’s assume that’s the inner canula. You take it out, you inspect it, you look for blockages, and then even if there isn’t the blockage, you put in a new inner cannula to have a clear airway. Then also what you need to do on a regular basis, you need to use humidified air or humidified oxygen depending on whether someone is needing oxygen or not, and you also need to use regular normal saline nebulizers. You can’t go wrong with a normal saline nebulizer.

I want to leave you there. I want to thank you for your attendance.

Thank you for your questions, and I’m looking forward to seeing you again next week around the same time. Next week’s topic is “Ventilation, Tracheostomy, IV Fluids, TPN, Central Lines, Dialysis. Can it be Done at Home?” That is next week’s topic and I want to leave you with that for today.

Have a wonderful weekend.

Thanks for watching and I’ll talk to you next week.

Take care.

If you have a loved one in intensive care, you should be contacting us at intensivecareathome.com. Call us on one of the numbers on the top of our website, or simply send us an email to [email protected].

Also have a look at our case studies because there, we highlight more about what we can do for our clients, how clients can live at home with ventilation and tracheostomies instead of in intensive care. And you can look at our case studies.

Intensive care at home Case studies

And if you are at home already, and you need support for your loved one, and you have insufficient support or insufficient funding, please contact us as well. We can help you with all of the above.

And if you are an intensive care nurse or a pediatric intensive care nurse with a minimum of two years ICU or pediatric ICU experience, and you ideally have a critical care certificate, we want to hear from you. Please contact us, check out our career section on our website. We are currently hiring ICU and pediatric ICU nurses for clients in the Melbourne metropolitan area, Northern suburbs, in Sunbury, in Bendigo, Mornington Peninsula, Bittern, Patterson lakes, Frankston area, South Gippsland, Warragul, Trida, Trafalgar, and Moe, as well as in Wollongong, and in Kensington, in Sydney, in New South Wales, and in Brisbane.

www.intensivecareathome.com/careers

We are an NDIS (National Disability Insurance Scheme), TAC (Transport Accident Commission), DVA (Department of Veteran Affairs), and iCare proof community service provider in Australia. Have a look at our range of full-service provisions.

Thank you for watching this video and thank you so much for tuning into this week’s blog.

This is Patrik Hutzel from Intensive Care at Home and I’ll talk to you in a few days.