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Today, I have a question from Marina who says,

“Hi Patrik,

My husband is 61 years of age. He’s on a ventilator with a tracheostomy in ICU. He’s got lung cancer. He’s got pleural effusion, and he’s got bile coming out of his chest drain and also coming out of his body. What will the treatment be like once he’s at home?

My name is Patrik Hutzel from intensivecareathome.com and let’s break down Marina’s question today so we can get an answer for everyone.

So, Marina, I’m very sorry to hear what you and your husband are going through. If your husband is being discharged home with the conditions that you’ve described, his care will likely focus on managing his symptoms and maintaining comfort, at least that’s what I can see from what you’re describing. It would be good to look at the full set of medical records. That would absolutely help because then I can give you even more information.

But first off, it sounds like he might need to remain on ventilator with a tracheostomy, which means you will need 24/7 in-home nursing support with Intensive Care at Home, with critical care nurses.

A home ventilator set up would include obviously ventilator, backup ventilator, suctioning secretions, so needs two suction machines, 2 monitors to monitor oxygen levels, heart rate, blood pressure, and also obviously to prevent any infections. You also need backup tracheostomy tubes, you need a hospital bed, a hoist, a seating hoist, all of that is what is needed.

If your husband goes home with a chest tube for pleural effusion management, which is unfortunately not unusual for someone with lung cancer, the pleural effusion needs to be drained regularly to relieve his breathing difficulties. So once again, that is within our scope, 24-hour critical care nurses to provide that level of management.

He may also need palliative care. It really depends on the overall situation. You haven’t shared anything that the lung cancer is treatable, whether he’s still on any treatment for the lung cancer, or whether he’s simply going home to have palliative care.

Now, with a bile drainage, it means that the flexible tube usually is inserted into the bile duct to allow bile to drain from the liver. That is typically being done when the bile ducts are blocked, and that might be secondary to the cancer having spread. Maybe he’s got metastases around the liver, that might be an explanation why he does have the bile drain in the first place.

So, obviously, we as nurses, once again, can manage and maintain the drain maintenance and prevent infections because it’s important that whether it’s the pleural drain, for pleural effusions or the bile drain is not getting infected.

In this situation, as far as I can see, it’s also a case of managing symptoms rather than aggressive interventions. But it really depends on your husband’s situation. Again, is the lung cancer treatable or not?

Next, you haven’t shared anything about pain management, but I would imagine if your husband has lung cancer, he needs pain management. So, the question is, what medication is used to relieve his pain, potentially breathlessness and discomfort?

If he’s already under the palliative care, they will adjust medications to keep him comfortable. But if he’s going home, we can definitely work with the palliative care team as well, or with the pain specialist to manage comfort.

Next, nutrition and hydration also need to be managed. In this situation, your husband needs a nasogastric tube or a PEG (Percutaneous Endoscopic Gastrostomy) tube, and then we can give him feeds and hydration via the PEG tube or the nasogastric tube. If he can’t tolerate food or water for whatever reason, then he might need TPN. TPN stands for Total Parental Nutrition, and it’s also known as IV or intravenous nutrition.

Next, if you or your family or your husband believe that the only way forward here is palliative care or hospice care and if the belief is that his condition cannot be turned around or remedied, then, he may go home for palliative care, and the focus will be on comfort care.

So, the question really is, are you or the hospital considering palliative care? Or does your husband want to go home because he wants to continue cancer treatment at home? That’s really the question here. But in any case, going home with, in this condition is definitely doable.

Another tip here is with the ongoing pleural effusions, I wouldn’t be surprised if his hemoglobin and his albumin levels are low. I’m a critical care nurse by background, of course, and I have seen many patients in those situations with low albumin or low hemoglobin levels.

So, the question is, does he need an albumin infusion? Does he potentially need a blood transfusion before going home? Have you spoken to his oncologist to find out whether that treatment can be continued at home or whether cancer treatment is continued at all? That would be a really important answer to find out.

But going home, absolutely doable. We can hire a team of critical care nurses that you know, like, and trust, of course. You know, like, and trust and that your husband feels comfortable with.

The cost is working in your favor because the cost of an ICU bed is around $5,000 to $6,000 per bed day and Intensive Care at Home is about 50% of that cost, which means whoever your funding body is will have an interest in reducing that cost down to 50%. The ICU will have an interest to empty their ICU bed because the ICU bed is the most sought-after bed in a hospital, generally speaking. So, once again, this is a win-win situation for everyone. I’m sure your husband and yourself, you’re sick of living in ICU, which is probably why you reached out in the first place.

So, 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 a long-term stay in intensive care for long-term ventilation, tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy, both for adults and children, with tracheostomy and without ventilation, Home TPN (Total Parenteral Nutrition), home IV potassium infusions, home IV magnesium infusions, IV fluids, and IV antibiotics. We’re also providing nasogastric tube management, PEG (Percutaneous Endoscopic Gastrostomy) tube management and PEJ (Percutaneous Endoscopic Jejunostomy) tube at home, central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port-a-cath management at home. We’re also providing ventilation weaning at home as well as cough assist management 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 Area Health District, their in-touch program, where we were going into the client’s home providing emergency department bypass service by changing nasogastric tubes at home, PEG tubes, changing IDCs (indwelling catheters), SPCs (suprapubic catheters), changing tracheostomy tubes, changing even casts. That service saved approximately $2,000 per patient that we keep at home, instead of them going to an emergency department.

Therefore, we are also in a position to cut the cost of an intensive care bed, just as I described, by around 50%. An intensive care bed costs between $5,000 to $6,000 per bed day. Our service costs between $2,500 to $3,000 per bed day and we’re freeing up the most sought-after bed in the hospital, which is the ICU bed. But most importantly, we’re improving the quality of life for patients and their families which is a win-win situation for all stakeholders.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We’re an NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as the Department of Veteran Affairs all around Australia. 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 currently 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 level of accreditation since 2012. No other provider has achieved this high 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, which enables us to look after the highest acuity adults and children in the community in Australia safely.

If you’re at home already and you’re watching this, and you’re watching this, and you realize that you don’t have the right level of support, or if you’re stuck in an ICU long-term, or if your family member is stuck in an ICU long-term, I’ll give you a real-world example today. One of our first clients about 10 years ago, when we first got started was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, it’s dangerous and negligent having support workers looking after a client at home on a ventilator with a tracheostomy. That is like flying the airplane with the cabin crew instead of the pilot because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies or even dying if they don’t have a team of critical care nurses looking after them 24/7. This is actually evidence-based in the community and is documented in our Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com where it’s clearly documented that only and exclusively critical care nurses with a minimum of 2 years critical care nursing experience can look after ventilation and tracheostomy, adults and children, at home safely.

Think about it, in an intensive care unit, in an ICU in a hospital, you wouldn’t have support workers looking after a critical care patient on a ventilator with a tracheostomy. So, why would anyone in their right mind would do that in a home care environment in the community? People have died because of this support worker model.

So eventually, this client found out about us and the ICU that he was going back to found out about us. We were proving our concept with this client very fast. When we worked with the client, we sent him intensive care nurses, 24 hours a day. He never went back into ICU ever again and we were proving our concept there very fast.

We can do the same for you if you’re not safe at home which includes the advocacy for funding that goes along with it. We have always successfully advocated for our clients. Otherwise, we would not be in business. The same is applicable for those stuck in an ICU, similar to our case study today to what you’re looking for, reach out to us. We’ll make it happen for you as well. We can take you through the right steps.

This is also why we are providing Level 2 and Level 3 NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS Support Coordinators, and I’ll put a link to an interview with Amanda in the written version of this blog below the video. 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 from another organization 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 what evidence to provide, I encourage you to reach out to us as well. 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.

If you are a critical care nurse and you’re looking for a career change, and you want to join a very progressive, dynamic, 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 are looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I have a disclaimer, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients also do want the same staff coming over and over again because they are very vulnerable and very special, and that’s why we need regular staff. So, if you’re looking for agency work where you can come and go, this will not be the right fit for you. We are looking for consistency and our clients are looking for consistency. So please, only apply with us if you can give us regular and consistent availability for shifts and you’re really keen on building relationships with us and with our clients.

If you are 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 you 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 and you get the same level of care, and you’re freeing up ICU beds.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, home TPN, please reach out to us as well. We can help you eliminate your bed blocks very fast.

If you’re in the U.S. or in the U.K. 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, 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, share this video with your friends and families, and comment below what you want to see next and what questions and insights you have.

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.