This blog post was first published at our sister site INTENSIVECAREHOTLINE.COM a support and resource website and blog for Families of critically ill Patients in Intensive Care.
Hi it’s Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can have real power, real control and so that you can influence decision making!
In last week’s questions we looked at breathing tubes and how long they can stay in. In this week’s episode of “your questions answered” we look at Tracheostomy tubes, what purpose they serve in Intensive Care and how long they can stay in.
So last week I touched on breathing tubes, their purpose and how long they can stay in. This week I want to talk about Tracheostomy tubes.
A Tracheostomy tube is often used in Intensive Care for the purpose to wean a Patient off the ventilator. It is usually the next step after somebody has been “deemed” a difficult or slow wean off the ventilator. Generally if your loved one is expected to be on the ventilator for more than 7 days, a Tracheostomy insertion would be necessary. This time frame might vary from unit to unit to plus minus a few days.
A Tracheostomy can be performed percutaneously(needle puncture of the skin) or surgically. Both techniques are widely used in current surgical practice and the difference from an ICU perspective is usually that the percutaneous Tracheostomy insertion is performed in Intensive Care by the ICU doctors and the surgical Tracheostomy is performed in the operating theatre by a surgeon.
Once a Tracheostomy has been performed, usually the sedation for breathing tube tolerance can be taken away and your loved one is able to be ‘woken up’. Once a Tracheostomy is in place ventilation can be tolerated so much easier, as generally no sedation is necessary. Your loved one will be able to have their teeth brushed properly and generally have good mouth care.
Also, Tracheostomy ventilation is so much easier to be tolerated as the Tracheostomy generally doesn’t cause any pain or discomfort.
As you might have already seen, your loved one can also have a good cough and suctioning sputum tends to be a lot easier as well.
Now, lets look at the most important part of the Tracheostomy in Intensive Care. Generally speaking, if your loved one is ventilated in Intensive Care and has a Tracheostomy, your loved one can be taken off the ventilator as soon as he or she is more awake and your loved one should then be in a position to be gradually weaned off the ventilator. It still might take a while and whilst the start of the weaning process can be slow, with maybe 2 hours off the ventilator per day initially and then increasing the time off the ventilator from there, it is a good starting point.
There still can be setbacks though during the weaning process and you and your critically ill loved one might have to be patient. It is hard to put a time frame on how long it takes to
a) Being weaned off the ventilator and
b) Have the Tracheostomy removed
It often depends on what other things your critically ill loved one has going on.
Sometimes Patients do go back to a ward with the Tracheostomy still in place and without a ventilator and sometimes both, the ventilator and the Tracheostomy will be removed before your loved one can go to the ward.
Sometimes the ventilation and the Tracheostomy might be prolonged and sometimes your loved one might end up staying in Intensive Care for a prolonged period. Setbacks such as infections or an extensive premedical history can make the weaning process more difficult. Other factors might come into play as well such as the lack of Quality of life and depression in Intensive Care.
So, I hope that this episode shed more light on Tracheostomies and ventilation in Intensive Care. If you have any questions just send them to [email protected] or to [email protected] and I’ll answer them personally!
For more information visit INTENSIVECAREHOTLINE.COM