This blog post was first published at our sister site INTENSIVECAREHOTLINE.COM a support and resource website for Families of critically ill Patients in Intensive Care.
Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM with another episode of “your questions answered”!
In this week’s episode I want to explain “How long somebody should a Patient be on a ventilator before having a Tracheostomy”, because again, this is a question that visitors to our website want to know quite frequently.
So your critically ill loved one has been admitted to Intensive Care and he or she requires invasive or tube ventilation with a tube in their mouth, attached to a ventilator and after a few days of ventilation, he or she is still unable to wake up and/or your loved one may still require the tube for ventilation or it may also be the case that your loved one still requires ventilation and is unable to tolerate the tube for ventilation and it is becoming a safety issue. You may have heard the doctors and the nurses talk about performing a Tracheostomy for your loved one, as your loved one is expected to require ventilation for a few more days or even weeks.
As a rule of thumb, it is usually advisable to perform a Tracheostomy after about 7-10 days of ventilation, if ongoing ventilation is expected and if a slow and difficult weaning off the ventilator is expected.
There are other, less common reasons as well that may lead to Tracheostomy, such as swallowing difficulties and/or difficult anatomy such as a short neck that may lead to a Tracheostomy.
The main advantages of a Tracheostomy generally are
• Less sedation is required for your critically ill loved one to tolerate ventilation- as you may have seen, your loved one may require a fair amount of sedation to keep him or her in an induced coma for ventilation. Having a tube in the mouth is very uncomfortable and requires sedation for tube tolerance. With a Tracheostomy, sedation can literally be weaned off immediately after the Tracheostomy has been performed and your critically ill loved one should be able to come out of the induced coma relatively quickly. Sometimes there are reasons, why your critically ill loved one may still require to stay in an induced coma, even after a Tracheostomy has been performed, however this would only be the case if your loved one remains very unstable for reasons such as raised intracranial(brain) pressures or haemodynamic instability such as low blood pressure and/or irregular heart rhythms or ECMO
• Weaning off the ventilator may be commenced the next day after the Tracheostomy has been performed, if your loved one’s condition allows. It may still be a relatively slow process, however your critically ill loved one should be able to spend the first hour or so off the ventilator, once the sedation has been taken away and an assessment can be made on how long it might take to wean your loved one from the ventilator
• Tolerating ventilation with a Tracheostomy is so much easier and doesn’t require a great deal of sedation so that your loved one should be able to at least try and mouth words and is able to move his or her lips. Also brushing teeth and performing mouth care is so much easier and it only improves the well being of your loved one
• Setbacks can be managed much easier with a Tracheostomy, I.e. if your critically ill loved one needs to go back on a ventilator after time off the ventilator has been achieved, it is easy to switch back and forth between spontaneous ventilation and mechanical ventilation. Often during the day time Patients are able to breathe without the ventilator but during night time mechanical ventilation is required for rest periods
• Mobilisation in a chair is usually a lot easier as well whilst having a Tracheostomy
• Your loved one may also be able to tolerate sips of water, tea or at least crushed ice and that improves your loved one’s comfort levels as well
There may be times when even a Tracheostomy does not improve your loved one’s condition in the short term and your loved one may have a hard, difficult and prolonged time in Intensive Care, because he or she is unable to be weaned off the ventilator.
Sometimes, despite Tracheostomy ventilation, your critically ill loved one may be kept in Intensive Care for long-term ventilator dependency and that can be a frustrating experience for both, your critically ill loved one and for the Family.
If this is the case, you, your Family and your critically ill loved one need to patient to a point and you also need to start thinking about alternatives, if your critically ill loved one stays in Intensive Care for too long. Again, as a rule of thumb, everything above 4 weeks ventilator dependent is far too long and generally requires an alternative approach.
In many countries such as Australia, Germany and the USA many long-term ventilated Adults& Children with Tracheostomy are going home with the help of specialized and dedicated Intensive Home Care services. Check out https://intensivecareathome.com for more information. This service provide a genuine alternative to a long-term stay in Intensive Care.
For more information and for more in-depth insight that you must know whilst your loved one is critically ill or is dying in Intensive Care, sign up for your FREE membership and download your FREE “INSTANT IMPACT” REPORT. In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care!
In this free report you’ll also discover
• how to ask the doctors and the nurses the right questions
• how to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
• 5 “killer” tips& strategies helping you to get on the right path to control, power and influence in your situation
• you’ll get ‘behind the scenes’ insight so that you understand what is really happening
• how you need to manage doctors and nurses in Intensive Care(it’s not what you think)
With your FREE “INSTANT IMPACT” report you’ll also get 4 other FREE reports and the reports you will be receiving are
- The 6 questions you need to ask the most senior doctor in Intensive Care
- 10 things you didn’t know doctors and nurses are talking about while you are not at the bedside with your loved one
- The 7 answers to the 7 most FAQ if your loved one is critically ill in Intensive Care
- 9 myths of being a critically ill Patient in Intensive Care
Thank you for tuning into this week’s blog and I’ll see you again in another update next week! Make sure you also check out our “your questions answered” section or send me an email to [email protected]
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
For more information and to get your FREE “INSTANT IMPACT” Report visit INTENSIVECAREHOTLINE.COM