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Hi it’s Patrik Hutzel from INTENSIVE CARE AT HOME where we provide tailor made solutions for long-term ventilated Adults & Children with Tracheostomies by improving their Quality of life and where we also provide tailor made solutions to hospitals and Intensive Care Units to save money and resources, whilst providing Quality Care.

In last week’s blog, I focused on

HOW TO INCREASE ICU BED CAPACITY DURING THE COVID-19 PANDEMIC CRISIS?

You can go and check out last week’s blog by clicking on the link below this video.

(https://intensivecareathome.com/how-to-increase-icu-bed-capacity-during-the-covid-19-pandemic-crisis/)

In today’s video, I want to answer a question from one of our readers and interested clients, Carrie and Carrie has a 72-year old husband in ICU now for four months and Carrie is wanting to know if he can go home with intensive care at home.

My Husband is in ICU for Four Months. Can He Go Home with Intensive Care at Home?

So I read out Carrie’s emails so you can understand what situation her and her husband are in. Because many families in intensive care are in a similar situation and they don’t know what they don’t know and they don’t know what to do, which is why they’re reaching out to us. And we can help them to take their loved one home and bring intensive care in their home. So that’s the whole idea.

So let me read out Carrie’s email now.

My husband is 76 and he had a right tibial artery blockage with loss of blood flow to his great toe. You had an atherectomy by a vascular surgeon done on December the 15th and nephrotoxic contrast media caused worsening of kidney dysfunction to stage five but gradually improved somewhat. The next hospital day, my husband had a heart attack and intermittent atrial fibrillation for the first time.

Prior to that he had a history of mild congestive heart failure. He got readmitted just a couple of days before Christmas with a right great toe amputation and then he went back home. His kidney function deteriorated and his third admission was just after the New Year for uremia with mental confusion and to start emergency dialysis.

About 10 days later, he developed his first hospital acquired pneumonia and he was very slow to respond to that with antibiotics. He then had an acute and rapid drop in oxygen levels around 4:00 AM on the 10th of January, and he was put on a ventilator for the first time. The infectious disease specialist thought it was probably secondary to a large mucus plug. His tracheostomy and his PEG tube was subsequently put in on the 27th of January.

During his stay in ICU, he also developed a sacral pressure ulcer during hospitalization which progressed markedly and after debridement and removal of large amount of tissue is now at a stage three pressure sore wound, which is treated by the wound care team and he has been on an air mattress. He was then a couple of weeks later developed a second hospital-acquired pneumonia and MRSA. He improved clinically with antibiotics and his white cell count decrease from 28,000 to 18,000 but has never returned to normal.

On the 20th of February, his white cell count was 14,500. His chest x ray has shown bilateral pleural effusions. It was worst on the right but also residual infiltrate on the right lung. Last week, he had chest drains inserted to drain the pleural effusions. Presently he’s having haemodialysis three times a week with additional treatments added or for fluid removal as needed.

The lengthy hospitalizations, multiple complications and lack of adequate nutrition have resulted in extreme weakness. My husband remains primarily bedridden except for being up in a chair for two-hour sessions, one to two times a day. He has continued to have paroxysmal atrial fibrillation, more frequently when he’s extremely tired or stressed. In terms of ventilation weaning, my husband had worked up to 24 hours of two times the ventilator but then had to start over because of the pneumonia and extreme fatigue. He has been on the tracheostomy collar for three 16-hour sessions in one 20-hour session this past week.

It has been a difficult and delicate balance between adequate fluid removal and the extreme fatigue associated with dialysis causing increased dyspnea. My husband had done well with trials of applesauce and diced peaches and we’ll have a swallowing test next week to further evaluate the possibility of feeding by mouth again soon. His current plan is to transfer him to a skilled nursing facility to a long-term weaning unit with the pulmonary unit that can care for tracheostomy and ventilator patients and also do in-house dialysis.

I am an advocate of holistic healthcare and would much prefer to have him at home and to have the ability to add appropriate supplements to his treatment regimen to strengthen his body and immune system. The ICU has been as aggressive as they could be with weaning. The problem for him is extreme weakness, balancing his fluid removal and dialysis, which are exhausting and avoiding atrial fibrillation which occurs again when he’s stressed.

He’s on his third attempt, he had worked up to being off at least one 24- hour period two different times and then had to go back on the ventilator again because of the second hospital-acquired pneumonia and the atrial fibrillation/arrhythmia issues. This time he has done three consecutive 16 hours off in a 20- hour period off, but just found out yesterday he’s going to be cut back to 12 hours because his arterial blood gases have deteriorated and his CO2 has risen again and it just looks like we’re fighting a losing battle and he can’t come off the ventilator in the meantime. So I feel like we’re stuck in intensive care and we’re really wondering what our options are. Could my husband go home with your service intensive care at home? From Kelly.

Hi Kelly,

here is what we can offer from our end. Of course, you know, it sounds like this is almost textbook. Your husband is stuck in intensive care for four months. He can’t go anywhere. He can’t be weaned off the ventilator. He’s taken up a very precious ICU bed, especially at the moment with the COVID-19 situation. And you know, the risk for your husband to get another infection in intensive care is very high, he’s already had two hospital acquired pneumonia and you know, he doesn’t need the third one. Because that might be his last one.

So the sooner your husband can go home in an environment where he’s more or less free from infection you know, in his own home care environment, not surrounded by other sick patients like he’s in ICU where the risk of doctors, nurses, physios, OTs and you name them you know, spreading infections from other patients to your husband, the risk is too high.

So from that perspective, that’s only one of the many reasons why your husband should go home. And you’ve already mentioned that you’re an advocate for holistic healthcare and we are certainly advocates for holistic healthcare for holistic intensive care.

Because you know, once a patient is out of the critical phase in intensive care, there is no need for them to stay and they can go home with our service intensive care at home and we can wean your husband off the ventilator at home. If he can come off, he can be mobilized regularly at home. He can be in the surroundings of your home, we can bring intensive care nurses into the home 24 hours a day and provide the intensive care substitution service. And also, as you might be aware, the intensive care bed costs about five to $6,000 per bed day and we can cut that cost to about half of the costs and provide similar care and treatment.

So, the hospital has an interest in freeing up ICU beds and also has an interest in cutting costs and we are the alternative for that and we can make that happen for you very quickly. We have taken patients home on a 24-hour roster within a week of notification and I know we can do the same for you with our intensive care at home service.

Again, four months in ICU is way too long. You know, patients get depressed, your husband has already shown that he’s prone for infections and the chances of your husband coming off the ventilator at home in his own environment where he probably would be much less depressed. You know, being surrounded by your family are so much higher to achieve that goal at home rather than in an intensive care environment where he’s surrounded by other sick patients where it’s noisy, it’s never dark, you know, it’s 24 hours a day and it’s just so much nicer at home.

And again, with our service, we’re providing a win-win situation by freeing up in demand intensive care beds and by cutting the cost of an intensive care bed by 50%. And that’s again a win-win situation. Also you are talking about home dialysis, again, we can either do the dialysis at home or he can even attend dialysis as an outpatient to a dialysis center. So that’s possible as well.

So thank you for writing in again Kelly and get in contact with us so we can take the next steps. You can also have a look at our case studies. I put a link below this video and you can see what other clients were looking after, but at the end of the day, you know it’s bread and butter for us to take patients out of intensive care or prevent intensive care readmissions mainly for patients with tracheostomy and ventilation and we’re doing that by providing a 24-hour intensive care substitution service with intensive care and pediatric intensive care nurses.

Thank you for watching this video. Again, if you have a loved one in intensive care with long-term ventilation and tracheostomy needs, you should definitely contact us on one of the numbers on the top of our website, or just simply send me an email to [email protected].

And if you are an intensive care nurse or a pediatric intensive care nurse, and you’re looking to get out of the craziness of an intensive care unit, and work for us in a much nicer and more holistic and client- centric environment, you should contact us as well and you should check out our career section on our website here

We have vacancies currently for experienced ICU and pediatric ICU nurses in Melbourne, on the Mornington Peninsula in Warragul, in the northern suburbs in Melbourne, and also in Sunbury so really all across the Melbourne metropolitan area, and you can escape the hustle and bustle of ICU and work in a much nicer and much more family friendly and holistic environment.

You can also have a look at our service section where we detail exactly how we deliver services or tailor-made services I should say for our patients and their families but also for hospitals and intensive care units. We have also been part of the Royal Melbourne Health Accelerator Program in the past for innovative health care companies.

Thank you so much for tuning into this week’s blog and I’ll talk to you in a few days. This is Patrik Hutzel from intensive care at home and I’ll talk to you soon.