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My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home, where we provide tailor-made solutions for long-term ventilated adults and children on bilevel positive airway pressure (BiPAP), continuous positive airway pressure (CPAP) at home, where we provide tracheostomy care at home without ventilation. Home cough assist management, home ventilation weaning, home total parenteral nutrition (TPN), home intravenous (IV) fluids, home IV antibiotics, home IV potassium, magnesium, and other electrolyte infusions, which goes hand in hand with central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, as well as port management at home, indwelling catheter (IDC), suprapubic catheter (SPC), nasogastric tube, nasojejunal tube, percutaneous endoscopic gastrostomy (PEG), and percutaneous endoscopic jejunostomy (PEJ) tube management at home, as well as palliative care management at home.

 

We are also providing level 2 and level 3 National Disability Insurance Scheme (NDIS) support coordination, as well as Transport Accident Commission (TAC) case management.

 

Today, I want to answer a really heartbreaking question from Linda, whose father suffered a cardiac arrest at home. Her husband found him unresponsive and purple on the bedroom floor. Cardiopulmonary resuscitation (CPR) was started, and he has been in ICU since Monday.

 

The ICU team has told Linda’s family that her dad has a hypoxic brain injury, that not enough blood and oxygen reached his brain, and that he has severe diffuse encephalopathy, which they have described as not reversible. Linda’s dad had also been unwell for the last two months, including a hospital admission in March for bleeding diverticulitis.

 

Linda has asked me four things.

 

What is the test that measures cortical response to a peripheral stimulus?

What does withdrawal of life support actually mean?

 

What are the family’s options to bring her dad home with Intensive Care at Home, and how can the family get a second opinion and a medical record review?

 

I will go through each of these the way I would explain it to any family member calling me directly.

 

Let us start with looking at the clinical picture, what hypoxic brain injury and encephalopathy actually means. When someone collapses in cardiac arrest, their heart stops pumping blood effectively, which means the brain stops receiving oxygen. Even a few minutes without adequate blood flow can cause what is called a hypoxic ischemic brain injury, hypoxic meaning lack of oxygen, and ischemic meaning lack of blood flow.

 

The two usually go together in a cardiac arrest situation. Encephalopathy is a general medical term for altered brain function. It simply means the brain is not working the way it should. When ICU doctors describe it as severe, diffuse, and not reversible, they are telling you it affects the whole brain rather than one localized area, and that in their clinical judgment, meaningful recovery is unlikely.

One thing I would flag for Linda’s family to clarify directly with the treating team: encephalopathy after cardiac arrest is typically described as hypoxic ischemic encephalopathy, not traumatic brain injury. Traumatic brain injury usually refers to a physical blow or a trauma to the head. If your dad fell during the collapse, it is possible he sustained a secondary traumatic injury on top of the hypoxic injury, or the wording may simply have been used loosely in conversation.

 

This is worth asking the treating team to clarify precisely in writing if possible because it changes how the situation should be explained to your family and can matter later if you request a medical record review. It is also important to separate brain damage from brain death. Brain damage or brain injury describes harm to brain tissue and function.

 

It exists on a spectrum from mild to catastrophic. Brain death is a distinct formally diagnosed clinical and legal state where all brain and brainstem function has permanently and irreversibly ceased, confirmed through a specific standardized testing protocol. You have told me the ICU team has not used the words brain dead for your father.

 

That is a meaningful distinction, and it means the conversation you are currently in is about prognosis and treatment goals, not a brain death determination. Let us now look at the test.

 

What is cortical response to a peripheral stimulus?

 

What Linda is describing is very likely a somatosensory evoked potential, also known as SSEP test, sometimes specifically the median nerve SSEP with N20 response. Here is how it works in plain language.

 

A peripheral nerve, usually the median nerve at the wrist, is given a small, painless electrical stimulus. Sensors on the scalp measure whether that signal successfully travels up the arm through the spinal cord and brainstem and reaches the sensory cortex of the brain. A normal result called a present N20 response shows the pathway to the cortex is intact.

 

A bilateral absence of that cortical response, meaning it is missing on both sides of the brain, is one of the most reliable indicators used in ICU medicine to suggest a very poor chance of neurological recovery after a hypoxic brain injury from cardiac arrest.

 

SSEP testing is usually done alongside, not instead of other tools, a clinical neurological examination, electroencephalogram (EEG), which measures the brain’s electrical activity and can show whether there is ongoing seizure activity or a severely suppressed pattern, and sometimes magnetic resonance imaging (MRI) brain imaging.

 

No single test is used in isolation to predict outcome.

 

ICU and neurology teams look at the whole picture together, generally not before 72 hours after the cardiac arrest, because early results in the first day or two can be misleading. Since Linda’s dad has not had his EEG yet, the full prognostic picture is not complete.

 

That is an important point to hold onto. Let us now look at what does withdrawal of life support actually mean. Withdrawal of life support, also called withdrawal of life-sustaining treatment, means stopping treatments that are keeping someone alive when those treatments are no longer expected to help them recover or are no longer in line with what the patient would have wanted. This can include stopping mechanical ventilation, inotropes, vasopressors, which are both medications that support blood pressure, dialysis, or artificial feeding, or things like extracorporeal membrane oxygenation (ECMO) or a ventricular assist device (VAD).

 

A few things every family should understand. Four key points.

Number one, it is a decision, not an automatic step.

 

Nothing is withdrawn without the family or the patient substitute decision maker being consulted and involved unless there is a legally binding advance care directive that already sets out the patient’s wishes.

 

Number two, withdrawal of life support does not mean no care.

 

Care shifts from curative, life-prolonging treatment to comfort and dignity, usually called palliative or comfort care, ensuring the person is not in pain or distress.

Number three, withdrawal of life support is very different from a do not resuscitate (DNR) or not for resuscitation (NFR) order, which only applies if the heart stops again.

 

Withdrawal is a broader decision about ongoing treatments already in place.

Number four, families are entitled to ask for time, for a second medical opinion, for a case conference with a full treating team, and for the reasoning and evidence like the SSEP and EEG results to be explained clearly before agreeing to any further steps.

 

You are under no obligation whatsoever to agree to a withdrawal of treatment on the timeline the hospital proposes. If you have doubts, questions, and it sounds like you do, you are entitled to ask for the complete medical records, test results, a second opinion from an independent intensivist or a neurologist, and if you choose, a formal medical record review.

 

Given everything your family has been through in the last few months, the diverticulitis bleed in March, ongoing poor health, and now his cardiac arrest, wanting a second opinion and a medical record review is completely reasonable. A medical record review looks at the chronology of care, the test results, and whether the clinical decision-making and communication with your family have been appropriate and can help identify whether anything was missed or should have been done differently.

 

As part of getting patients home with Intensive Care at Home, we offer this kind of consulting and medical record reviews through our sister site intensivecarehotline.com, and we would be very glad to help your family understand the medical records, the test results, and your options in plain English.

 

You can check out intensivecarehotline.com, our sister site, where we provide consulting and advocacy for families in intensive care. Let us now look at if your dad comes home, let us look at the Intensive Care at Home options.

If your father stabilizes and the family wants to explore bringing him home rather than remaining in ICU or in hospital, whether that is with a tracheostomy, on a ventilator, on BiPAP or a CPAP, without tracheostomy, with a tracheostomy without ventilation, or simply needing high-level nursing support with Intensive Care at Home, that is exactly what we specialize in.

 

Our approach is evidence-based. You can read the details below how we manage long-term home ventilation here with our evidence-based mechanical home ventilation guidelines. It is also worth knowing that Intensive Care at Home is the only Intensive Care at Home nursing service in Australia in 2026 and is third-party accredited for Intensive Care at Home nursing.

 

We are NDIS registered as well as International Organization for Standardization (ISO) 9001:2015 accredited. I put the links to both of that in the show notes. Third-party accreditation matters because home ICU nursing with a tracheostomy or ventilator can be complex and can be perceived as high risk.

 

It should only ever be delivered by 24-hour critical care registered nurses, ICU nurses, not downgraded to general registered nurses or community registered nurses, let alone to disability support workers. We provide 24/7 critical care registered nurse-led care all around Australia in all states and territories, as well as in all metropolitan, regional, and remote areas.

 

We employ hundreds of years of critical care nursing experience combined. That enables us to look after complex clients at home very safely. If you are watching this and you are in the United States, the United Kingdom, Canada, or India, and you are interested in Intensive Care at Home as well, I encourage you to reach out. I know we can help you there as well.

 

Contact us at intensivecareathome.com. Call us on one of the numbers on the top of our website or send us an email to info@intensivecareathome.com. If you are in Australia, you can contact me on my mobile phone, 041 094 2230. That is once again 041 094 2230.

 

Linda, the bottom line, I am so sorry your family is facing this. Ask the treating team to clarify hypoxic versus traumatic brain injury in writing. Ask for the completed EEG, full SSEP results, computed tomography (CT) scan of the brain, MRI scan of the brain, before any decision is finalized. Remember that brain damage is not the same as brain death, and know that you can request more time, a second opinion, and a medical record review before agreeing to a withdrawal of treatment.

 

If your dad does come home, including palliative care on your terms, Intensive Care at Home is here to help with accredited, evidence-based, 24/7 critical care registered nurse-led care.

 

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.