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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,
You can check out last week’s blog by clicking on the link below this video:
In today’s blog post, I want to answer a question from one of our clients and the question today is
How to Make INTENSIVE CARE AT HOME for your Loved One Safe and Possible! Live stream!
Welcome to another Intensive Care At Home livestream today.
In today’s video, I want to talk about how to make Intensive Care At Home possible and safe for your loved one in intensive care, and obviously, the safety aspect is a big issue when it comes to Intensive Care At Home. I want to elaborate on that today in as much detail as possible. I want to talk about some case studies in how it’s possible. Before I go into today’s topic, how to make Intensive Care At Home possible and safe for your loved one, just a couple of housekeeping issues.
If you have questions to today’s topic, please type them into the chat pad. I will also give you the opportunity to dial into the show a little bit later after I’ve gone through today’s topic. Just want to quickly elaborate on a known case of what makes me qualified to talk about today’s topic. I am an intensive care nurse by background, have worked in intensive care for over 20 years in three different countries. I have also worked as a nurse unit manager for over five years in intensive care. I am the founder of Intensive Care at Home. We’ve been in business now for over 10 years. We’re looking after long-term intensive care patients at home, long-term intensive care patients with tracheostomy and ventilation. And we’ve been doing so successfully for over 10 years now.
I am also the founder of Intensive Care Hotline consulting and advocacy service for families in intensive care where we consult and advocate for families in intensive care all over the world. But without further ado, let’s focus on today’s topic – How to make Intensive Care at Home possible and safe for your loved one in intensive care? But also, if you are at home already, because quite frankly, it needs to be safe and there are patients at home already that are not safe and they’re looked after by families or they’re looked after by support workers or by general registered nurses and people have died because of that so the safety aspect is very important and cannot be neglected. What is safe when you take someone home from intensive care? And probably also, I should give you a very good case study about the safety aspect.
Our very first client when we first started out with Intensive Care at Home, was a client who was at home on a ventilator with a tracheostomy, C1 spinal injury client, young male at the time and he was looked after by a mixture of support workers, which is basically no health professions, people picked off the street with all due respect to the people, but people who had no formal education and they were looking basically after an intensive care patient at home and also some general registered nurses and he bounced back into ICU every second day because they simply did not have the know-how, how to keep him at home and that was our first client.
We were given the opportunity at the time to prove our concept and it only took us a couple of weeks to prove the concept because as soon as this client had intensive care nurses, he never went back to ICU ever again. We’ve proven the concept very, very quickly, but also with proving the concept what I didn’t mention initially about my experience is I worked with Intensive Care at Home 20 years ago in Germany where we were pioneering the concept then and when I came to Australia, it was crystal clear to me that there’s a need for this here as well and that we can do the same here.
Intensive care in first world countries are very similar. The issues are very similar. People end up with a tracheostomy after they can’t be weaned off the ventilator with a breathing tube and then if they can’t be weaned off the ventilator at all, then the options for them are limited and one option is going home. That’s what we are here for, to do at Intensive Care at Home. That’s our mission, that’s our goal, that’s the quality of life and in some instances, quality of end-of-life for our clients all over the world really.
Yes, Modema, you need it in the U.S. too. We’re not there yet. Unfortunately, we’re not there. We are very busy here. We have so many Inquiries from the U.S. and if anyone watches this, we’re also open to partner. If there are organizations in the U.S. and you’re watching this video, we’re open to partner. We can give you the know-how and we can give you also referrals because we have so many inquiries from the U.S. If you are watching this and you are interested in partnering, contact us at intensivecareathome.com. You can call us on our U.S. number there, or you can simply send us an email to [email protected]. But let’s stick with the case studies for now.
Just going back to our first client that we had here in Melbourne, we followed the mechanical home ventilation guidelines, I should say the evidence-based mechanical home ventilation guidelines and those guidelines are clearly saying that ventilated patient at home, invasively or non-invasively, ventilated patient at home needs to have 24 hours intensive care nurses with a minimum of two years ICU experience. And that’s one huge aspect of making it safe at home. Other aspects of course are equipment, staff selection, how the house is set up. There are other aspects of the safety as well, but predominantly it’s a skill selection first and foremost. That’s what we’re all about here at Intensive Care at Home. It’s all about quality and safety. It’s all about sending quality staff into the home and that’s how we manage the safety aspect of it.
Then, as we went along in our journey, providing Intensive Care at Home, what we were finding, another aspect that happened along our journey here in Melbourne, was that there was a child in the community that had a tracheostomy, wasn’t ventilated, but had a tracheostomy, had seizures, was again, was looked after by a mixture of support workers and general registered nurses and the child died at home because a medical emergency could not be managed by non-qualified staff and the child passed away and that at some point opened up the doors for us at the children’s hospital here in Melbourne because we were the safer option. We are the safer option because we exclusively work with critical care trained nurses and that eventually proved our concept with children and that’s how we’ve been operating ever since and people have now embraced our concept because it’s simply the safer option.
Whilst we know we can cut the cost of an ICU bed by approximately 50%, you can’t cut the cost of an ICU bed by 60, 70, 80% by working with support workers or general registered nurses. Quality comes at a price, while still saving the healthcare system 50% of the cost of an ICU bed, plus you have an empty ICU bed that can be used for other critically ill patients, especially in the times of COVID and ICU beds were in high demand before COVID, they are still in very high demand, so that you understand where we are coming from. And also in the meantime, to further highlight the safety and quality aspect and further highlight the importance of the mechanical home ventilation guidelines that you can only take patients home from ICU and only look after invasive and non-invasive ventilation outside of intensive care with intensive care nurses with a minimum of two years ICU experience is that we had some clients in the meantime where we were only funded for night shifts, ventilated clients, clients with a tracheostomy, and there was no day shift funded with an ICU nurse.
As we predicted at the time with the clients and also with the funding bodies in this situation, it was the NDIS (National Disability Insurance Scheme) here in Australia, the clients passed away during the day because medical emergencies for tracheostomy clients happen all the time. But if you don’t have a critical care nurse there that knows what to do with an airway, with an unstable airway, the clients passed away. It’s extremely sad and I hope that some bureaucrats here from the NDIS are watching and that you know what you need to do going forward when we put forward proposals for our clients, when we put forward doctor’s letters and nursing assessments where it’s black and white and crystal clear that patients with mechanical ventilation at home need an ICU nurse 24 hours a day with a minimum of two years ICU experience.
Now, our critical care workforce here at Intensive Care Home, we’re employing hundreds of years of intensive care nursing experience that we bring in the community and that’s very unique because as far as I’m aware, there’s no other organization that actually takes intensive care nursing skills into the community. That brings in another level of specialty into the community.
Also, talking about the safety aspect, we are now partnering with an organization, a great organization, it’s called My Emergency Doctor and we can get an emergency doctor, telehealth consult 24 hours a day and we are now preventing hospital readmissions by using them. We’ve also done the other day, not too long ago, we’ve done our first chest x-ray at home, so there are now organizations that have the same values that we have and are working towards the same goals than we do. Basically, bringing intensive care into the home and keeping our clients at home. Nobody wants to go into a hospital. That’s madness, especially if it can be prevented. And again, talking about the safety aspect, especially during COVID and during lockdowns, none of our clients, not one, got COVID because some clients had concerns that because most of our staff are still working in ICU as well, that staff would bring in COVID from ICU. I mean, again, that is just nonsense because staff in ICU know how to protect themselves. It’s PPE (personal protective equipment) and common sense.
Again, none of our staff brought in COVID from an ICU back to our home care clients, never happened. So again, that’s really important for people to understand the safety aspect of what we are doing and that people should not be driven by mainstream media, but they should be using their own good judgement and their own good judgement says, “Well, common sense, washing hands, wearing PPE is protection against COVID.” I hope that helps you understand again more about the safety aspect, not only taking patients home from intensive care, but also how does it need to be set up.
Next. Staff selection. Again, like I said, we are working according to the mechanical home ventilation guidelines, we are selecting staff with the minimum of two years ICU experience, especially when we have new clients going home. We usually use some of our experienced staff that have been involved in successful transitions from ICU to a home care environment. We use those staff to guide the rest of the team, maybe our younger team to make that transition a success so that we can achieve our KPIs, which are zero non-elective readmissions back to ICU. And another goal is to have all shifts filled, of course. That’s very important.
Then we need to look at things such as equipment of course. What equipment do you need before you go home for someone on a ventilator with a tracheostomy? You need to look at what ventilators are needed. It’s often a Resmed Astral 100 or 150. A patient or a client needs two ventilators, one main ventilator, one back-up ventilator of course, one is often with a wet circuit with a humidifier and the other circuit is a dry circuit and patients are going out when you can’t take the humidifier with you. But it is really important to have humidified oxygen, especially when patients are at home or clients are at home.
Modema, it is fairly complex. You’re making a comment, you can’t even imagine how complex it is. It is reasonably complex, but again, it’s also our area of expertise so one could say, one might say it is complex. On the other hand, we are living and breathing this and it’s just our area of expertise and we just do it. But it is reasonably complex. But that’s also why we’re trying to employ staff that are competent in this area that have experience in this area, and to make what some people might perceive as impossible so that we can make the impossible possible. So, that’s the equipment you need. Suction machine or suction machines. Again, you need two suction machines. One main one, one as a backup. One should be a portable one so when you’re going out that you can have a portable suction machine with you. You need a monitor to monitor heart rate, to monitor saturation, you need, again, like a small pulse oximeter that when you’re going out you can measure oxygenation. You need often a nebulizer, right, nebulizer machine so that saline nebulizers can be given or a Ventolin nebulizers or Atrovent nebulizers can be given for our clients.
You also need emergency equipment such as a resuscitation bag. You need spare tracheostomies. If a client has a size 8 tracheostomy, you need a size 7, one size smaller as well in case you can’t reinsert the size 8. You need tracheostomy dilators. You need PEEP valves. You need Guedel airways. You need a nasopharyngeal airway. You need a Duoderm dressing just in case you need to seal off the tracheostomy in case you can’t reinsert it so you could start bagging through the mask. So we are well prepared for this home care environment and again, we have a checklist what needs to happen before someone goes home? You need to have, ideally hospital bed, you need to have hoist, if it’s not a ceiling hoist or a lift, you need a portable hoist or a lifting machine is another term. Ideally, you need a hospital bed with an air mattress or a soft mattress at the very least to prevent pressure sores. Most of our clients need a wheelchair. There are some clients that are still mobile or at least semi mobile, but most of our clients are wheelchair-bound when they can get mobilized. Most of our clients during the day still go out or can go out.
Again, they often need a modified vehicle or if they don’t have a vehicle, they can often order a Maxi Taxi for example, that’s suitable for wheelchairs. A lot more is possible at home than you think there is, but the first thing that needs to happen is that patients get out of intensive care as quickly as possible. That’s often the most important step in all of this.
Next, very important staff selection. Some of it is of course dependent on location. We have some very difficult locations that are outside of the metropolitan areas and sometimes we have gone to great lengths in some remote locations here in Australia. We have flown in our staff into remote towns from Sydney or from Melbourne or from Brisbane. We’ve done all of that. It can be done. Some remote areas there are no ICU nurses, but in order for a client to leave ICU, the only way it can be done is by flying in and flying out staff. Or we have other clients here that are two hours away from Melbourne, two and a half hours away from Melbourne and we are often sending staff there for two or three shifts in a row and we are putting them up in a hotel if they’re open to that. We have been very creative around how we can make Intensive Care At Home possible and also how flexible our staff are and how much they embrace the concept coming from ICU.
In terms of staff selection, we often want to do, or we do want to do a meet and greet with our clients, of course, ideally have a meet and greet. If we can’t do it in person, we can do it via video, via Zoom, making sure we select the right staff for your family, for your home, for our team, it has to be the right dynamics, has to be the right fit for you and your family and that is often easier said than done but knowing that there’s going to be some trial and error in the beginning until we’ve got the right team together. But again, we’ve done it many times now and we think we can match the right staff with the right client, with the right family to make it a win-win situation so that everyone is happy.
In the ideal world, we also have a team leader on a roster that can train new staff, help with staff selection, be the mediator between the family and the team and us. That helps as well. And then again, I’m painting the ideal scenario here. We could start with some shifts in the hospital even and almost get some handover shifts from the hospital where we can get to know you, where we get to know the client and where we can get all the necessary ins and outs of the clinical issues from the hospital and then the transition is so much easier.
Let’s quickly talk about funding. Let’s quickly talk about the finance side of things. Most of our clients at the moment here in Australia are funded through the NDIS (National Disability Insurance Scheme), but there’s also some TAC funding, there are some DVA funding, Department of Veteran Affairs, TACs, the Transport Accident Commission here in Victoria. And that’s where the funding is coming from, especially with the NDIS, the National Disability Insurance Scheme. And this is talking now to all the complex support coordinators out there or specialist NDIS support coordinators out there, how to go about funding for a critically ill patient on a ventilator with a tracheostomy or even if they’re non-invasively ventilated on BiPAP or on CPAP, you should really talk to us about how you get the maximum funding. We have helped so many clients now to get the maximum funding through our advocacy and our clinical expertise. You should contact us if you have questions around that, how to get the maximum funding and how to get the ICU nurse funded in home care. We can help you with all of that.
Very soon, we are also in the process of providing specialist support, coordination ourselves, but we are not quite there yet. We’re just in the middle of setting it all up and we should be ready by the end of this year or early 2023 at the latest. I will keep you informed here on this channel and on our website how we go about providing our own specialist NDIS support coordination. But with other funding bodies, whether it’s the TAC, DVA, Department of Veteran Affairs or the NDIS of course, you should contact us. You should also contact us if you are under iCare in New South Wales and we can help you with obtaining funding there as well. That’s a little bit about the funding side, but you shouldn’t really concern yourself too much with the funding side of things. There are experts including ourselves that can take care of that. Your focus should be in setting it all up, talking to the right people and getting your loved one home. And if you are in a situation like where you don’t have the right support at home, where your loved one is at risk of going back to hospital or is going back to hospital because you don’t have any support, you have for example support workers or you have general registered nurses that are not intensive care trained, you should contact us as well.
We know the implications, we know the difference. I make a very, again, I make the bold statement here that if you don’t have intensive care nurses at home with your loved one on a ventilator, invasive ventilator or non-invasive ventilation, your loved one is at risk of dying. Unfortunately, we’ve seen it over and over again and I talked about this in the beginning of this video.
The same is applicable. The mechanical home ventilation guidelines are also applicable when it comes to tracheostomy at home that are tracheostomy clients at home that are not ventilated. Same issue that without an ICU nurse 24 hours a day, your loved one is at risk of hospital readmission or potentially dying. Unfortunately, this has happened many times in the community now when best practice is not followed and best practice, once again is an intensive care nurse at home 24 hours a day. Those intensive care nurses need to have a minimum of two years ICU experience. Once again, we are employing hundreds of years of ICU experience in our workforce in Sydney, Melbourne, and Brisbane now, and we are also branching out to Adelaide and Perth. If you are watching this and you’re in Adelaide or in Perth, please contact us at intensivecareathome.com as well.
Next. So I talked about the funding side of things, that it shouldn’t concern you too much. The funding is there. We just need to talk to the right people, present the right documents, get all the doctors’ letters, get all the nursing assessments, and off you go. And again, if you’re an NDIS support coordinator or a specialist support coordinator watching this, you should contact us as well and we can help you with your NDIS participant getting the funding there. Okay.
And don’t forget your consulting work. It’s imperative. Yeah, look, the consulting is always, it is to a degree imperative. I’m glad you mentioned it, Modema. Actually, just before I went on YouTube live now, I was talking to a client actually in the UK as part of my consulting work, and there is a client in the UK in London who’s been in ICU for 120 days.
The client’s been admitted there in June initially for cardiac surgery, followed by complications such as cardiac arrest, heart attacks, arrhythmias and so forth. And he’s now stuck in ICU for 120 days with pulmonary fibrosis. Now, the family, the ICU wants to withdraw treatment and the family wants to take him home.
Now, the UK doesn’t have Intensive Care At Home yet, but I do know of a couple of organizations in the UK that are probably equipped to take a patient home on a ventilator with a tracheostomy. As a matter of fact, we have helped a family in Kent in the UK just in 2019 to help their loved one home, to help their loved one from ICU going home after nearly 12 months in ICU on a ventilator with a tracheostomy. So we’ve helped the family with the advocacy by showcasing to the doctors in ICU in the UK what we are doing here to make it clear to them it’s all possible as long as you have a service provider that can pull it off. And there was a service provider in the UK that was able to pull it off.
Arabella, if you’re watching this, I’m talking about your dad and that was a great success story. So yeah, the consulting work is part of it, Modema, for sure. And as you can see there’s overlap. Sometimes people come to us asking for Intensive Care At Home and I say, “Well, your family member doesn’t need Intensive Care At Home or is still a while away from potentially needing it”. And then we go into consulting mode in helping the families in intensive care how to advocate for their loved ones. That’s part of our work.
I hope that gives a good overview of what needs to happen to make Intensive Care At Home safe for adults and for children. Really, it’s critical to have the ICU nurse 24 hours a day when it comes to ventilation with tracheostomy, non-invasive ventilation via BiPAP or CPAP and also home TPN. We’re also doing home TPN for anyone of you who doesn’t know what, if you haven’t heard of TPN, it stands for Total Parenteral Nutrition. It’s basically IV nutrition given via a Hickman’s line or via PICC (peripherally inserted central catheter) line and we have helped so many clients, again, going home with TPN so they can have that in the comfort of their own home. We’ve done TPN for adults, for children, for all ages really so you can check out home TPN services intensivecareathome.com as well.
Other things that I want to highlight about, again, about the safety aspect. We have looked after some patients at home now on a ventilator with a tracheostomy or any other client that is in need of an intensive care 24 hours a day at home for over five years. There is longevity in this and don’t get me wrong, we’ve also had clients at home for a short period of time that went home for palliative care. It’s not a one size fits all. If you think you want to take your loved one home for palliative care, you should definitely contact us as well. There are numerous options available for you to leave intensive care, whether it’s to wean off the ventilator, wean off the tracheostomy, whether it’s for palliative care, there’s numerous options for you and for your family available. You should absolutely contact us with any questions you might have there.
I think that sums it up for today in terms of how to make it safe and sustainable to take your loved one home from ICU and have Intensive Care At Home. If there are any questions now about today’s topic or any other topic, any other intensive care related topic, please type your questions into the chat pad or you can also now, if you like, call into the show, I’ll give you the phone numbers. If you are in Australia, you can call live into the show on 041 094 2230, that is again, Australia 041 094 2230. Also, New Zealand, if you dial +61 before the number. If you are in the U.S. you can call into the show on 415 915 0090. That is again 415 915 0090. And if you are in the UK, you can dial into the show on 0118 324 3018. That is again, UK 0118 324 3018. Waiting for your calls. The lines are open.
Yeah, as I mentioned, we’ve looked after clients at home now on a ventilator with the tracheostomy or non-invasive ventilation like BiPAP or CPAP for over five years, 3, 4, 5 years depending on the clients. And don’t get me wrong, it’s a challenge every day, but it’s a great challenge to work with and we believe our team is up for it and you can take advantage of it if you know are in a position and you think your loved one needs to go home on a ventilator or wants to go home, more importantly.
I also want to quickly talk about age brackets so especially here in Australia, the NDIS is cutting off at 65 years of age and there is no insurance at the moment for clients above the age of 65 unless they’re already on the NDIS. But you should definitely contact us because especially if you have private health insurance, if you have also, there should also be Department of Health funding because again, it’s a win-win situation with saving the health system so much money by saving the cost of an ICU at 50%. But also if you’re watching this and you are a hospital or you are from a private health insurance, you should contact us as well because we can help you save money, we can help you freeing up your ICU beds and we can help you giving your patients what they want, giving your patients and families what they want. That is good publicity for you as a hospital.
Think long term, think what patients and families want. Think what you want. Again, I think we’re all here, whether you’re a patient, whether you’re a family, whether you are a health funding body, whether you are a government funding body, we’re all here to have the same goal. Take pressure off the hospital system, give patients and families what they want, and provide quality of life for patients and for families and save money. We’re all here for the same reasons. It’s a win-win for everyone. Can’t stress that enough.
And also, another word to our U.S. audience or UK audience, you should definitely contact us one way or another because we know of a couple of organizations in the U.S. in particular that can do Intensive Care At Home in some areas we are definitely open to talking to them and putting you onto them. We are really not sure how good they are. We know of one organization who seems to be pretty good in the Virginia area, but other than that, again, it is a highly specialized skill and the organizations need to know what they’re doing. And also we have developed so much intellectual property about intensive care, we’ve got our own policies and procedures and they’ve only been coming really out of years of experience of doing that. I believe no other organization worldwide has developed any such insights with the exception of the companies in Germany that have been doing it even for longer than we have.
Okay, thank you for posting your question here. You are asking, “My girlfriend is 18 and she’s 38 days in a coma after severe TBI (Traumatic brain Injury). I’m scared.” Okay, tell me more about your girlfriend. Why she’s in a coma? Is she in an induced coma or is she in a natural coma? “Her head is still swollen.” Okay. Question to you is, is she in an induced coma, induced by medication or is she in a natural coma? And also why is her head still swollen? Can you share more about that? That would be really helpful if you can give as much detail as possible. Also, with traumatic brain injuries, did she have surgery? Did she have a craniectomy? Did she have parts of her skull removed? Is she having an EVD drain, an extra ventricular drain? Is she having seizures? What’s her Glasgow coma scale?
It would be great to have as much information around that as possible because then I can really dive deep and help you with this. It might also help if you can dial into the show, it would be great to get you on the phone so we can have a discussion here. “She was two weeks in an induced coma and then they let the medicine wear off and she didn’t wake up.” Okay, thank you for sharing that. Okay. Do you know what her Glasgow coma scale is like? Have you heard of Glasgow Coma Scale? “One week after the TBI, she had an edema.” Okay. Do you know what her Glasgow scale is like? Have you heard of the term Glasgow Scale? Glasgow Scale is a neurological assessment tool in intensive care or for any neurological patient. It would be helpful if you can share with me what her Glasgow coma scale is like. “I think the lowest possible.” Okay. That would be a Glasgow coma scale of 3, which would be similar to what some people might refer to as a vegetative state. “Under 8 for sure.” Okay. Okay.
Are you in a position to see your girlfriend? Are you visiting her every day? How often do you see her? Would be helpful to know whether you see her or whether you’re getting this information secondhand from another family member. You see her. Okay, great, great. And have you asked them what stops her from waking up? Have you asked them? Okay, you see her every day? Fantastic. Have you asked them what they think stops her from waking up? They must give you a reason why they think she’s not waking up. You’re getting it secondhand. Okay. Right. Why is she not waking up? What are they telling you? Is it the brain injury itself? Is it sedation still not worn off? What is it that keeps her from waking up? Is she not getting physical therapy? Is she unable to be moved? Is she unable to be stimulated because of the brain injury? Are they stimulating her and she’s still not waking up? Those are all very important questions.
The swelling even. Yeah, swelling might stop her from waking up. It might. Has there been a midline shift? Do you know if there has been a midline shift and do you know if she had a craniectomy? A craniectomy is a partial removal of the skull, you know whether she had any of that?
Again, the more information the better. “The reason she’s not waking up is because of the injury and I’m sure the edema.” Okay. “She had a craniectomy.” Okay. Right. That’s good to know. Do you know when they shine a light in your girlfriend’s pupils, do you know if the pupils are reacting to light? You know any of that? Yes. And like Modema says, “Don’t give up”.
So while I’m waiting for your answers to elaborate a bit more on what’s going on there with your girlfriend. “No, I don’t know that. I’ll ask though.” Yeah, so that’s another really important question. Ask them when they shine a light, a torch in her pupils, are they reacting to light or not? Because it would be very important that the pupils are reacting to light. You said she’s been in there for 38 days. From memory, I would have to scroll back to through your text 38 days. Well, I can tell you what I see as good news here. The good news seems to be they’re not giving up. “We are so young, my life is destroyed.” No, your life is not as destroyed when you are 19. Definitely not. You only perceive it as your life being destroyed. You can’t change what’s happening to you because you’re not in control of it, but you are in control of how you react. It’s the only thing you can control. The good news here is your girlfriend is in ICU for 38 days and they’re not giving up and there must be a reason why they’re not giving up. I’ve seen plenty of situations where ICUs give up on people way too early. So you got to look at the positives. Okay.
What other questions are there from the people that are here, would welcome you to type in more questions or call into the show. “And she’s still on a ventilator.” Oh. On a ventilator, no tracheostomy. That sounds strange to me. She would need to have a tracheostomy after two weeks. Why is she not having a tracheostomy? That requires, there’s real hope. Don’t despair. Yeah, just get informed. Yep, exactly. Just get informed. “And her breath is 75% by her own.” So why is she not having a tracheostomy after 38 days? That doesn’t sound right to me. Why?
A tracheostomy should be done after about day 10 or 14 when someone can’t come off a ventilator. Now that’s assuming that your girlfriend was ventilated from day one in ICU. I’m assuming that, and I remember you were here on the show the other day, but it would, if you can clarify please, whether your girlfriend has been ventilated from day one going into ICU. And I also need to apologize.
I had another YouTube live scheduled last Saturday. Last Saturday U.S. time, Sunday morning here and I couldn’t make it because I was too busy with the client and I do apologize that the session from last week will be done next Saturday or Sunday here, my time.
Modema, you’re saying it’s 28 days maximum in the US? Yeah. Look, the literature, it’s worldwide sort of day 10 to 14. Yes. It seems to get a little bit longer, generally speaking maybe because of COVID, I believe. Okay, so you are saying that you think that your girlfriend has been ventilated from day one in ICU. So I argue she needs to have a tracheostomy as quickly as possible, assuming she can’t get off the ventilator in the next few days. What stops them from doing a tracheostomy? Do you know? It would be really helpful to find out what stops them from doing a tracheostomy. In your eyes or have they told you what stops them from doing a tracheostomy? So yeah, I missed last week’s. I do apologize for that. But normally I’ve got this time blocked out unless something urgent happens. Right, you really don’t know why they haven’t done a tracheostomy. I would try to find that out as quickly as possible.
It may hinder her of waking up. It may not be the only reason, but it may be one of the reasons. I’m surprised to hear that she can tolerate the breathing tube because it’s very uncomfortable, very uncomfortable. I hope that helps to guide you in the right direction here. But it will also help be helpful. What medications is she on? Does she have seizures? That would be very helpful. They think she doesn’t need it because she’s breathing almost by her own. Yeah, that is a reason only if patients are awake. If you are telling me your girlfriend is not awake, she will need a tracheostomy because she won’t be able to protect her airway if she’s not awake. Right. She will need a tracheostomy if she’s not awake.
Therefore, even though she might be breathing by herself and she might be able to even get off the ventilator, she nevertheless will need a tracheostomy because if she’s not awake, there’s a high chance that she will aspirate that she can’t swallow if she’s not awake. And then she will end up with an aspiration pneumonia and she will need to get a tracheostomy anyway. So even though she might be close to breathing by herself, that doesn’t necessarily stop her having a tracheostomy, especially when she’s not awake. And this is what I’m saying when I’m saying over and over again, the biggest challenge for families in intensive care is that they don’t know what they don’t know. They don’t know what to look for, they don’t know what questions to ask, they don’t know their rights, and they don’t know how to manage doctors and nurses in intensive care. And this is exactly one of those situations where, yes, they might wait for her to breathe by herself, but if she’s not waking up, she will need a tracheostomy. And I argue that after day 38 in ICU of mechanical ventilation and a breathing tube, she does need a tracheostomy full stop.
Okay. I think your next step is to yes and Modema, you’re right in saying that if she breathed 75% on her own, that’s good. But it’s too vague to say even that, it’s too vague. It really comes down to ventilator settings. If she’s breathing by herself on her own, that’s great. But on what other supports? Blood pressure support, oxygen levels. Again, it’s very nuanced. It’s very nuanced in terms of what needs to be considered in situations like that.
Okay. I slowly want to wrap this up today, unless there are any other questions. “How much time does the swelling does to heal?” Very difficult to say. Do you know if she’s having an extraventricular drain in her brain to drain fluids? Modema, you’re saying without consciousness she can’t clear her lungs and cough? Absolutely. Absolutely. That’s why she will need a tracheostomy if she’s not awake.
With the swelling in the brain, are they giving her medication such as Mannitol to drain fluids from the brain? Does she have a drain in the brain? So those are all questions that I would want to be curious of.
Okay, so you don’t know, you need to get as much information as possible, you should get access to the medical records. And I understand you may not be the power of attorney, but you need her family to give you access to medical records. “When I see her head, it’s wrapped up.” I see, I see. Right.
But anyway, look, you should be getting access to medical records as quickly as possible, or you may want to bring a family member here on this show next time. Modema you’re saying, “time takes time. I’ve heard of people in similar situations remaining unconscious for many, many, many months close to a year.” Absolutely. Absolutely. No one can predict the future. I can’t predict the future. All you can do is give it a go. It’s the only thing you can do. Give it a go.
I’m going to wrap this up slowly. Again, we’ll be back again next Sunday at 10:30 AM Sydney and Melbourne time, which by then will be 6:30 PM on a Saturday Eastern Standard time. I do believe, no, it’ll be 7:30 PM Eastern Standard Time and it’ll be 4:30 PM Pacific time on a Saturday, next Saturday. And it’ll be 11:30 PM UK time on a Saturday. Next Saturday for the next YouTube live.
If you have a loved one in intensive care, go to intensivecarehotline.com. Call us on one of the numbers on the top of our website or send us an email to [email protected] or check out of course intensivecareathome.com.
If you need home care for your loved one in intensive care, or if you’re at home already and you don’t have enough support, contact 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].
Also, have a look at our membership for families in intensive care at intensivecaresupport.org. They have access to me and my team 24 hours a day asking questions about intensive care and Intensive Care At Home. If you need a medical record review, please contact us as well and I would welcome, give the video a like, give it a thumbs up, share the video with your friends and families, subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home on regular YouTube lives and click the notification bell and comment below what you want to see next, or what insights you have.
And I really want to thank you for all your support.
Share the video far and wide and please give the video a like so the algorithm is more favorable towards our YouTube videos here and we can help more people give the video a like. Thank you so much and I’ll see you next time.
Oh, and here we’ve got Claire saying, you mentioned there is at home ICU available in Virginia. Is there possible ways to do ICU at home in New York? What is the name of the company in Virginia? Is at home ICU available in other countries? Claire, there is, I wouldn’t say there’s Intensive Care at Home available in Virginia, but here is what I do know, we were contacted by a family in Virginia a while ago in South Beach, I think it is.
Initially, we couldn’t help them and then the family reached out to us again and saying, Hey, we found a provider here in Virginia. They seem to be pretty good in helping us with some nurses. I would not feel a hundred percent comfortable sharing the name of the company here on the video live, but I would be very happy to share it with you in private. Send me an email to [email protected]. That is again send me an email to [email protected] and I will get back to you with the details.
Now, is there possible ways to do ICU at home in New York? Yes, I have been in contact with a gentleman in New York over the last 18 months probably, he’s running a sort of similar organization than we do in New York. I am not sure, and I will tell you this, I am very unsure about the capabilities of this service, but again, I would be happy to pass on his contact details and you would be welcome to contact him. I’m not comfortable sharing it here on a live platform. But again, if you send me an email to [email protected], we’ll be very happily sharing those details with you.
Now, your last question, is At Home ICU available in other countries? Absolutely. So we are providing Intensive Care at Home here in Australia. We are now operating in Melbourne, Sydney, and Brisbane. There is Intensive Care at Home available in Germany, Austria, and Switzerland. As I mentioned, I was involved in setting up Intensive Care at Home in Germany in the early 2000s. We were pioneers then, we were pioneers here in Australia. It can be done, it’s doable. It’s been done for decades now and one day we will be in the US. I hope that helps Claire, before I wrap this up. Send me an email and I will get those details to you.
Okay, I want to wrap this up. I will see you again next week at the same time. I hope you’ll have a wonderful weekend. Give the video a like and I want to thank you for all your support and I’ll talk to you soon.
Thank you.
Now, if you have a loved one in intensive care and you want to go home with our service intensive care at home and if you want to find out how to get funding for our service and how it all works, please contact us on one of the numbers on the top of our website, or send me an email to [email protected]. That’s Patrik, just with a K at the end.
Please also have a look at our case studies because there we highlight more about what we can do for clients, how clients can live at home with ventilation and tracheostomies and you can look at our case studies as well at our service section.
Intensive care at home Case studies
And if you are at home already and you need support for your critically ill loved one at home, and you have insufficient support or insufficient funding, please contact us as well. We can help you with all of that.
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, please contact us as well. 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, Sunbury, Bendigo, Mornington Peninsula, Bittern, Patterson Lakes, Frankston area, South Gippsland, Drouin, Warragul, Trida, Trafalgar and Moe as well as Wollongong in New South Wales.
www.intensivecareathome.com/careers
So we are also an NDIS (National Disability Insurance Scheme), TAC (Victoria) and DVA (Department of Veteran affairs) approved community service provider in Australia. Also have a look at our range of full service provisions.
Thank you for watching this video and thank you for tuning into this week’s blog.
This is Patrik from Intensive Care at Home and I’ll see you again next week in another update.