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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 care 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. We also provide Home TPN (total parenteral nutrition), Home IV potassium, Home IV magnesium infusions as well as IV antibiotics 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.

We have also provided an emergency department bypass service for the Western Sydney Local Area Health District because we have been sending our critical care nurses into the home to avoid emergency department admissions as well.

So, today I have a question from Jane that I want to answer, and Jane says,

“Hi, Patrik.

My dad is 66 years old. He’s has been in ICU for 14 days. Two days ago, they did a tracheostomy because he couldn’t breathe on his own. He’s still on the ventilator after the tracheostomy because he still can’t breathe on his own. The doctor said they will try and wean him off step by step, and it is really important if his heart and brain can endure this during this challenging time. He is having neurological problems. The brain is not giving signals to the respiratory system to breathe.

All his other organs seem to be OK. His vital signs seem to be stable as well. He does open his eyes. He sheds tears sometimes. He responds to stimuli, answers to the commands given by doctors and nurses but when told to breathe, he tries but gets tired immediately because his muscles are too weak.

He was also diagnosed late last year with Parkinson’s disease, diabetes, and he had some brain damage because of some brain strokes he had. The last three months, he was also losing weight because he couldn’t eat and had sleep deprivation during the night and slept a lot during the day.

Is there hope for him? How much can it take him to recover? What can we do for him? Can we take him home if he can’t be weaned off the ventilator in ICU?

From, Jane.”

Well, Jane, thank you so much for reaching out with your question.

It’s probably way too early to see where this is going, given that he’s only had a tracheostomy a couple of days ago but given that he had a stroke and he’s been diagnosed with Parkinson’s, weaning off the ventilator might be slow and challenging.

Also, if he couldn’t sleep at night but slept a lot during the day, I’m also wondering whether he might have sleep apnea, and whether he has a high CO2 or carbon dioxide is high because that might also mean he needs some form of ventilation going forward. Obviously, your question there to ask is, what is his CO2 like? And if he can’t come off the ventilator, they probably need to do a sleep study to work out what he needs going forward, whether he needs ventilation at all, assuming he can’t be weaned off the ventilator. You do mention that he’s too weak at the moment. Hopefully, that can change with getting him out of bed, getting him physical therapy, physiotherapy, doing breathing exercises, it is a bit too early after two days to see where this is going.

However, having said all of that, let’s just paint a good scenario here. Best case scenario is he gets weaned off the ventilator and gets weaned off the tracheostomy, he might still need BIPAP overnight or CPAP because of potentially him having high CO2. But once again, this is something you need to find out.

Let’s just take another scenario. Let’s just say he can be weaned off the ventilator, but because he’s got Parkinson’s and because he’s got the strokes, does he need a tracheostomy going forward but no ventilator? Even then, you will need Intensive Care at Home because anyone at home with a tracheostomy, especially as vulnerable as your dad is, needs critical care nurses, 24 hours a day, because he does have an unstable airway. He does have a device i.e. the tracheostomy that can only be managed by critical care nurses with a minimum of two years critical care nursing experience, and that is evidence-based.

You can look that up on our website at intensivecareathome.com, and you can find the evidence at our Mechanical Home Ventilation Guidelines, they are evidence-based. They are a result of over 25 years of Intensive Care at Home nursing in Germany and over the last 10 years here in Australia, so it’s all evidence-based.

Having said that, coming back to your email, Jane, what needs to happen here? If they can wean him step by step, that would be amazing. Like I said, with this therapy, with mobilization, with breathing exercises, I am positive that they can wean him off the ventilator. Yes, he’s weak at the moment because he’s been in a coma for nearly two weeks, that’s all, unfortunately, part of the parcel in intensive care, but that not should not stop you from giving up. It’s probably just at the beginning of a slow and lengthy recovery.

Now, like I said, the Parkinson’s as well as the strokes might be in the in the way of weaning him off the ventilator and it might be in the way of getting the tracheostomy removed if he can be weaned off the ventilator, either way.

The other thing that you need to look for is if he has been losing weight for the last three months. He needs his nutrition optimized. I presume he would have a nasogastric tube now. If he can’t be weaned off the ventilator, if he can’t be weaned of the tracheostomy, he does need a PEG (Percutaneous Endoscopic Gastrostomy) tube down the line, but not right now because it’s way too early to make an assessment of where he’s going next.

Now, if your dad can’t be weaned off the ventilator, can’t be weaned off the tracheostomy, definitely look at Intensive Care at Home. From our experience, from our perspective, after having helped so many clients improve their quality of life and in some instances, their quality of end of life at home, it is the best option. It’s also the best option for the ICU, because an ICU bed costs $5000 to $6000 per bed day. Intensive Care at Home is about half of that cost. So, it’s a win-win situation for everyone.

You are currently living in ICU, day and night, you and your family; that is also less than ideal, whereas if we bring the intensive care into the home, your quality of life and your family’s quality of life will improve drastically as well. But given some time and then it’ll all unfold and then if you need funding, I encourage you to reach out to us because we can help you with funding.

If you are in a similar situation, if you have a family member in hospital in a similar situation, or if you’re at home already and you have insufficient support, I encourage you to reach out to us here at the intensivecareathome.com. Call us on one of the numbers on the top of our website or send us an email to [email protected].

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

Like I mentioned before, we are also sending our critical care nurses into the home to keep emergency departments empty and do an emergency department bypass.

We are also providing Level 2 and Level 3 NDIS Support Coordination. So if your NDIS Support Coordinator is telling you, you can’t have nursing care for your loved one or you can’t have this, you can’t have that, I encourage you to reach out to us here at intensivecareathome.com and have a chat to our NDIS Support Coordinator who will help you to get the best out of the NDIS and out of your NDIS plan.

Unfortunately, we have seen over the years that a lot of NDIS Support Coordinators are not real strong advocates. They don’t understand the clinical, most of them are not clinical people. Here in Intensive Care at Home, we have someone that speaks the NDIS language, and we speak the clinical language, and that together is rocket fuel for our clients to help them get the NDIS plan they need and deserve, and it is clinically justified, of course.

If you are a NDIS Support Coordinator and you’re looking for nursing care for your participants or more funding because you don’t know how to advocate for nursing care, please reach out to us as well. We also do NDIS specialist nursing assessments.

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, pediatric ICU, or ED and if you ideally have completed a postgraduate critical care qualification, we have we currently have jobs in Melbourne, Sydney, Brisbane, Albury, Wodonga in Bendigo, as well as in Warragul in Country Victoria. We want to hear from you.

We are looking for intensive care nurses or critical care nurses that want to complement our team, people who are team players, people who are looking for regular work. We are a service provider with a tailor-made solution for our clients. We are not an agency. We do pride ourselves on providing this tailor-made solution to our clients. So, if you’re looking for agency work and you want to pick up shifts here and there, please don’t apply. Only apply if you’re serious and if you want to make a difference to our client’s life, if you want to work with them regularly, build relationships with our clients as well as with us of course, as an organization.

If you are an intensive care specialist and ICU consultant, we are currently expanding our medical team. We want to hear from you as well.

If you’re an intensive care specialist or ICU consultant and you have bed blocks in your ICU, 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, sometimes quality of end of life for your patients and their families, and you won’t even pay for it.

If you’re a hospital executive watching this, we also want to hear from you because again, we can help you eliminate bed blocks in ICU, ED, etc.

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

If you are in the U.K. or in the U.S., we can help you there privately. Please reach out to us as well.

If you like my videos, subscribe to my YouTube channel for regular updates for families in intensive care and Intensive Care at Home. 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. I also do a weekly YouTube live where I answer your questions live on the show.

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.