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Mom’s in ICU for 6 weeks, Unable to Wean Off Ventilation & Tracheostomy After CABG (Coronary Artery Bypass Graft), I Want Her Home

Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and 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 adults and children with tracheostomies. Also, otherwise medically complex adults and children at home including Home BIPAP (bilevel positive airway pressure), Home CPAP (continuous positive airway pressure), home tracheostomy care when adults and children are not ventilated, also Home TPN (total parenteral nutrition). We also provide IV potassium, IV magnesium infusions at home as well as IV antibiotic infusions at home. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as palliative care services at home, and that also includes ventilator weaning at home.

Now today, I want to answer a question from one of our readers, Morgan, who says,

“Hi Patrik,

My mother is in ICU after an emergency CABG, CABG stands for Coronary Artery Bypass Graft, also known as open heart surgery, about 6 weeks ago. We have been told by the ICU that we should prepare for hospice because she is ventilator dependent with a tracheostomy.

Before all of this, she had no prior health problems other than breast cancer 15 years ago. She had chemotherapy and radiation. She also had complications during a cardiac catheter procedure which resulted in a coronary dissection, which is a rupture of a coronary artery and cardiogenic shock, which is the reason for the emergency coronary artery bypass grafts, also known as CABG or open heart surgery.

She had multiple complications postoperative including bleeding heart failure and 3 days of CRRT. CRRT stands for Continuous Renal Replacement Therapy. It is also known as dialysis or hemofiltration. Her kidney functions are close to normal now. She was on sedation  for 14 out of 21 days in cardiac ICU before going to the general ICU.

On admission to the general ICU, we were told that she had severe sepsis and 2 small strokes that were discovered once the CT scan was done. She also had to get a tracheostomy during her stay in the cardiac ICU since she was unable to come off the ventilator before going to the general ICU.

Since the emergency coronary artery bypass graft, her ejection fraction is 40% but we are now being told she has metabolic encephalopathy since she’s not consistently responsive to commands and has been back on sedation for 14 of her 29 days in the general ICU.

She has also been failing her ventilation weaning program. I believe this has to do with the fact she has been back on sedation due to anxiety and becoming tachypneic. The settings are FiO2 of 30% and PEEP of 5.

We feel the ICU team are giving up on her too soon because she’s costing them too much time and resources. They are making me feel guilty as if I’m making her suffer but I think there is hope I want to give quality of life to her at home. How can we get her home? Thank you so much for all that you do.”

Thank you, Morgan, for sharing your email.

First off, thank you for detailing your mom’s situation and thank you for thinking ahead. You should give yourself a pat on your shoulder because you can see that in ICU, you can see that her needs are not getting met in ICU. You can also see your needs and your family’s needs are not getting met in ICU.

She’s failing ventilation weaning. Now, I couldn’t tell you whether she can be weaned off the ventilator or not but given that it’s been 6 weeks now. It’s time that you are looking for an alternative approach and also for a proven approach and the Intensive Care at Home is not only an alternative, it’s also a proven approach.

Now, you are mentioning that her settings are FiO2 or 30% and PEEP of 5, that’s just a small snapshot of what a ventilator is doing. You haven’t mentioned what ventilation mode she’s in. Has she passed a spontaneous breathing trial? Is she breathing SIMV (Synchronized Intermittent Mandatory Ventilation), ACV (Assist-Control Ventilation), CPAP (Continuous Positive Airway Pressure) pressure support, BIPAP? So, it’s not clear to me what are her ventilator settings.

But in any case, the next step really is to get her home because, once again, your mom’s needs are not being met. She’s anxious in there, which is why she’s sedated again. Our clients at home are not sedated because they’re not anxious at home. They’re in their own environment and they can live the life they want to live in their own environment as opposed to an intensive care environment where there’s simply no quality of life and in some instances, no quality of end of life.

I’m not sure whether your mom is in an end-of-life situation, whether she can be weaned off the ventilator. She certainly will need some cardiology input with an ejection fraction of 40%. She certainly will need some input from nephrology with her kidney failure. But one way or another, you already know that we are providing a win-win situation here because the ICU bed is $5,000 to $6000 per bed day. Intensive Care at Home is approximately half of that cost. Plus, the quality of life for your mom in ICU is poor. She’s anxious, she’s on sedation. She shouldn’t be anxious, and she shouldn’t be on sedation.

Also with health insurance paying $5,000 to $6,000 per bed day or public system paying $5,000 to $6000 per bed day, by cutting the cost of an ICU bed by approximately half is of the interest of everyone. Again, it’s a win-win situation. The hospital is not going to pay for it. You’re not going to pay for it. The reality is, it’s a win-win situation. We’re freeing up an ICU bed, which is the most sought-after bed in an ICU or in a hospital. It makes perfect sense.

We will then organize equipment for you. We will hire a team for you that you are comfortable with. It’s not like in an ICU where nurses and doctors are coming and going. We’re creating a stable team for your mom, the people that she knows, likes, and trusts. The people that you know, like, and trust. That’s not an overnight process, but we’ve done it many, many times, and we can do the same for your mom in this situation.

So, you’re on the right track here. Don’t let anyone dissuade you of not taking your mom home because it can be done. Once again, it’s a win-win situation for everyone. So, reach out to us for more information.

Now, if you have a loved one in intensive care in a similar situation and needs Intensive Care at Home, please reach out to us as well. Go to our website 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].

Or you might be at home already and you might have insufficient support, and then we can also help you. Many of our clients had insufficient support. They were at home already, but they were going back to ICU all the time because they either had support workers looking after their loved ones or general registered nurses that are not ICU trained and people have died because of that, or they go back to hospital all the time.

Our clients don’t go back to hospital unless it’s something elective because we can keep them at home predictably because we provide critical care nurses at home, 24 hours a day, for adults and children that are on ventilation with tracheostomies, but also for adults and children that are not ventilated but have a tracheostomy, adults and children that don’t have a tracheostomy but BIPAP, CPAP ventilated, Home TPN, IV potassium, IV magnesium, IV antibiotics, PICC line, central line, Hickman’s line management, port management, and palliative care at home.

Now, we are currently operating all around Australia, in all major capital cities as well as in regional and rural areas. We are an NDIS (National Disability Insurance Scheme) approved service provider all around Australia. We are a TAC (Transport Accident Commission) approved service provider in Victoria, an NIISQ (National Injury Insurance Scheme in Queensland) approved service provider in Queensland, an iCare approved service provider in New South Wales, as well as a DVA (Department of Veteran Affairs) approved service provider all around Australia. We have also received funding through public hospitals as well as departments of health and private health funds. So, reach out to us if you need help.

We are also providing Level 2 and Level 3 NDIS specialist support coordination if you need help with that. We are also providing NDIS specialist nursing assessments if you need help with that.

We are also currently providing an emergency bypass service for the Western Sydney Local Area Health District where we send our critical care nurses into people’s homes or sometimes into residential aged care facilities to keep EDs empty and do the ED at home. We can do the same for your healthcare service and for your ED. Now, if you are in the U.S. or in the U.K. and you’re watching this, we can help you there privately. Please reach out to us as well.

Now, also, like I mentioned, if you’re at home already, you have insufficient support. Please reach out to us as well. The NDIS in Australia is actually funding nursing care. Contrary to popular belief, just needs to go through the right advocacy process, which we are the experts in, so please reach out to us.

If you’re an NDIS support coordinator and you’re looking for nursing care for your participants or for more funding because you don’t know how to advocate for nursing care, please reach out to us as well.

If you are a critical care nurse and you’re looking for a career change, we want to hear from you as well. If you have worked for a minimum of two years in critical care ICU or ED, and if you ideally have completed a postgraduate critical care qualification, we currently have jobs in Sydney, Melbourne, Brisbane, Albury, Wodonga, as well as in Bendigo Country, Victoria, as well as in Warragul Country, Victoria. We want to hear from you.

We are looking for people that want to complement our team, people who are team players, and people who are looking for regular work. We are a service provider and not an agency. We pride ourselves on providing a tailor-made solution to our clients. So, if you’re looking for agency work and you want to come and go, please don’t apply. Only apply if you want to make a difference to our client’s life, and if you want regular work and that includes working with our clients on a regular basis.

Now, if you are an intensive care specialist, we are currently expanding our medical team. We want to hear from you. If you are an intensive care specialist and you have bed blocks in your ICU, which I know you do, and I encourage you to reach out to us as well. We can help you eliminate your bed blocks but more importantly, we can improve the quality of life and sometimes quality of end of life for your patients and their families.

If you are a hospital executive watching this, we also want to hear from you because, again, we can help you eliminate bed blocks in ICU and ED, please reach out if you need help.

Our website again is intensivecareathome.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].

Now, if you like my videos, subscribe to my YouTube channel for regular updates for Intensive Care at Home, but also for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next what questions and insights you have from this video.

Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com and I will talk to you in a few days.

Take care for now.