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If you want to know if your critically ill loved one can be weaned off the ventilator at home instead of in ICU after many months of failed weaning in ICU, stay tuned! I have news for you.

Hi, my name is 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 at home whilst providing quality care for long-term ventilated adults and children with tracheostomies at home. We also provide care to otherwise medically complex adults and children at home including Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure) ventilation, home tracheostomy care when adults and children are not ventilated, also Home TPN (Total Parenteral Nutrition), home IV potassium infusions, home IV magnesium infusions, 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 at home and that also includes ventilation weaning.

We are also providing our critical care nurses for home care to avoid emergency department readmissions. So, besides keeping ICU beds empty, we also keep emergency department beds empty by sending our critical care nurses into the home for PEG (Percutaneous Endoscopic Gastrostomy) tube changes, nasogastric tube changes, tracheostomy tube changes, catheter changes, even cast changes, and other things to keep emergency departments empty.

So, today I have an email from Anna who says,

“Hi Patrik,

My sister has been in ICU since the beginning of January. She had open heart surgery. She has many health issues, heart failure, and her kidneys only working 10%, so she’s on dialysis. She has been ventilated from the beginning of January in the last six weeks with the tracheostomy tube.

But unfortunately, all trials of weaning her of mechanical ventilation failed as every single time she ends up with carbon dioxide poisoning. Her mental state is really compromised.

Why can’t she be weaned? Can she go home, and can she be weaned at home?

From, Anna.”

Well, Anna, let’s break down your email in more detail so you can see the answer to your questions.

First off, yes, she can be weaned at home. Absolutely, that’s certainly what we’re here to do at intensivecareathome.com. That is our purpose, that is our mission. It’s really heartbreaking to hear about your sister’s difficult situation.

In essence, weaning a patient off mechanical ventilation in ICU but also at home can be complex and challenging. Especially when they have multiple health issues like in your sister situation, like heart failure, kidney problems, and obviously, complicated by prolonged mechanical ventilation with the tracheostomies. There are several factors that contribute to the difficulty in weaning ventilation such as the underlying health conditions with the heart failure and severe kidney dysfunction, which may compromise her overall ability to tolerate the stress of weaning mechanical ventilation.

Next, with prolonged mechanical ventilation comes when you are on a ventilator for an extended period of time that can weaken simply the respiratory muscles and make it harder to breathe independently. You’re also talking about carbon dioxide retention that suggests that her lungs may not be efficiently clearing carbon dioxide or CO2, possibly due to lung disease or other factors affecting the gas exchange. There might be a respiratory shunt, it’s called shunting. Also, there could be alveoli collapse and so forth.

Next, you’re saying that your sister’s mental health is compromised. The compromised mental health you mentioned could also affect her ability to cooperate with weaning protocols or breathe effectively on her own, and that also goes in with a compromised neurological condition. The reality is that patients in ICU, especially long-term patients, have no quality of life in ICU. But they do have quality of life with Intensive Care at Home because we are bringing the intensive care into the home, and this is much better and much more conducive environment for quality of life and quality of life increases the chances to wean mechanical ventilation.

Also, what’s the medical team’s approach at the moment? I’m sure they’re working diligently to find the right balance between providing respiratory support and trying to wean your sister off the ventilator safely. They would consider factors like a lung function test, blood gases, and overall clinical status. However, it is a complex situation that requires careful management and consideration of multiple factors. It might also be helpful to discuss these concerns with her medical and nursing team to better understand the specific challenges she’s facing and the strategies they are employing to address them, which also includes mobilizing her. You haven’t mentioned anything about mobilizing your sister, which is always part of successful weaning.

I haven’t seen it in a different way, so I am surprised you haven’t mentioned anything about mobilizing your sister and doing the physical therapy daily. And also, what you haven’t mentioned as well is having a weaning plan. Most successful long-term weans that I’ve seen in ICU or at home go hand-in-hand with the weaning plan. You haven’t mentioned anything of that, so I’m wondering, is anyone leading the weaning off the ventilator? Also, what you haven’t mentioned is what ventilation settings is she on.

The biggest challenge for families in intensive care is that they don’t know what they don’t know. They don’t know what to look for. They don’t know what questions to ask. They don’t know their rights and they don’t know how to manage doctors and nurses in intensive care.

So, what ventilation settings is she on? Now, I’ll give you a hint. If she’s ending up with carbon dioxide poisoning, I’ll give you a hint. I’ve worked in critical care for nearly 25 years in three different countries where I also worked as a nurse manager for over 5 years. We’ve been running Intensive Care at Home since 2012.

So, I can tell you what I’ve seen when there’s carbon dioxide poisoning or too much carbon dioxide in the blood. She may go from a controlled ventilation mode such as ACV (assist control ventilation) or SIMV (synchronized intermittent mandatory ventilation) to CPAP or pressure support. Once you drop the pressure support, her breathing rate might go up and her tidal volumes might go down, and that’s when you end up often with high carbon dioxide because patients simply can’t hit the mark of breathing independently.  So that’s when you got to put them back on in SIMV or you have to increase the pressure support to a point where weaning might get delayed. Yes, your sister might be able to breathe in pressure support or CPAP, but the support she’s getting is too high to do spontaneous breathing trials and get her on to a T-piece or the tracheostomy mask and so forth. So, that is what I’ve seen over and over again.

But then again, that’s when physical therapy, mobilization, also a good day and night rhythm is important. But then again, patients in ICU find it very difficult finding a good day and night rhythm in ICU because it’s noisy, the lights are on all the time, people are walking around, and talking all the time. Whereas at home, patients can much easier get back into a normal day and night rhythm because if patients don’t sleep at night or don’t sleep well at night, which is often the case in ICU, they are tired during the day, making it hard for them to wean off the ventilator.

Once again, think about that. If you are in a busy ICU, doctors and nurses are around 24 hours a day, lights on and off, because doctors and nurses need to do things with patients. There’s often a disturbed day and night rhythm. Picture that at home, it is much quieter, it is much more patient and family friendly, it’s a win-win situation. That’s why weaning at home is so much more conducive compared to a busy, noisy ICU where patients and families simply don’t have any quality of life, they simply don’t. So, that’s why going home is the right option here.

So, let’s talk about going home in terms of what does that look like. First off, the ICU needs the bed. Your sister has been there since January. The ICU is crying out loud needing that bed, there’s no question about that. ICU beds are in short supply. The next critically ill patient is already knocking at that bed, needing the bed. So, the ICU has an interest in freeing up the bed. Whoever is paying for the ICU bed pays $5,000 to $6,000 per bed day. With Intensive Care at Home, we can cut the cost of the intensive care bed by approximately 50%, so whoever’s funding the bed would have an interest in minimizing the cost, slashing the cost by 50%.

You and your family member obviously have every interest in going home because you’ve had enough of it. Clearly, that is what you’re showing in your email. So, we would need to set up equipment at home, ventilator, suction machines, monitors, special care bed like a hospital bed, hoist or a lifting machine, and you always need two ventilators, backup ventilator, oxygen, like an oxygen concentrator, and some cylinders, oxygen cylinders to have backup, and then go home.

Obviously, we hire an intensive care nursing team that can look after your sister, 24 hours a day, and we will select the right people for working with your sister. We create the right home care team for your sister. That’s the process, it is not more complicated than that, but you can see the complexities in ICU and then obviously, someone needs to oversee the weaning. But that’s all doable, that’s just all the nuts and bolts that need to be put in place to take your sister home.

We’ve been that done it many times. Like I said, we’ve been in business since 2012 and I also worked with Intensive Care at Home in Germany in the in the early 2000s. I have a ton of experience with this type of work. We are employing hundreds of years of intensive care nursing experience combined in the community. We are third-party accredited for Intensive Care at Home. No other service, I argue, worldwide has achieved that level of accreditation with the exception of nursing services in Germany. But in the English-speaking world, no other service has managed to go through a third-party accreditation for Intensive Care at Home like we have. So, we have all the policies, procedures, the intellectual property, the teams that have the insider knowledge what needs to happen to take your loved one home in a situation like that.

Now, with Intensive Care at Home, we are currently operating all around Australia and all major capital cities as well as in regional and rural areas. We are a NDIS (National Disability Insurance Scheme) approved service provider all around Australia. We are a TAC (Transport Accident Commission) approved and WorkSafe approved service provider in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme) in Queensland, as well as the Department of Veteran Affairs approved service provider 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 at intensivecareathome.com. Call us on one of the numbers on the top of our website or send us an email to info@intensivecareathome.com.

Like I mentioned, we’re also sending our critical care nurses into the home or into residential aged care to keep emergency departments empty and avoid emergency department presentations for our clients. If you want that for your hospital or for your residential aged care or for your family member at home, please reach out to us as well. We have done this successfully for the Western Sydney Local Area Health District for the in-touch program changing nasogastric tubes at home, PEG tubes at home, catheters, IDCs (indwelling urinary catheters) and SPCs (supra-pubic catheters) at home, changing tracheostomy tubes, changing casts even. Anything that can be done at home, we are doing. When we change nasogastric tubes at home, we also have the option to do home X-rays with a mobile radiology company that will do X-rays at home.

Now, if you are at home already and you’re ventilated with a tracheostomy or you’re ventilated with BIPAP, CPAP, or you have a tracheostomy and you’re not ventilated, and you realize you need more help and you need intensive care nurses instead of other supports you might have, we know a lot of patients on ventilation, tracheostomy at home with insufficient support and they’re going back to hospital all the time or even worse. We know of some patients that have died because they didn’t have the critical care nurses and ICU nurses, 24 hours a day. I’m not making this up, I’m not joking. This is serious business, so reach out to us if you need help because we can assemble the right team around you. We can also get the right funding for you. Many organizations don’t even know how to get funding for critical care nurses, we obviously do, so please reach out to us as well.

We’re also providing Level 2 and Level 3 NDIS Support Coordination. If you want to know more about our Level 2 and Level 3 NDIS Support Coordination, please reach out to us as well. I’ve actually done an interview with Amanda, our NDIS support coordinator and I will link below this video.

If you’re a NDIS support coordinator working for another organization and you’re looking for nursing care for your participants, please reach out to us as well. We are also providing NDIS specialist nursing assessments, and we’re providing nursing assessments for any other funding body or organization if you need them, especially when it comes to very complex ventilated and tracheostomy clients in the community or in ICU and in hospitals. If you’re a NDIS support coordinator struggling with getting nursing care for your participants, please reach out to us as well. Once again, we have been successfully involved in the advocacy for our clients for nursing care at home from Day 1. That also is applicable if you are a family member or a patient who can’t get nursing care through the NDIS, please reach out to us.

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 in critical care for a minimum of two years and you ideally have completed a postgraduate critical care and nursing qualification, we want to hear from you. We currently have jobs in Sydney, Melbourne, Brisbane, Albury, Wodonga, Bendigo in Country Victoria, as well as in Warragul in Country Victoria, we want to hear from you.

Please keep in mind we are looking for critical care nurses that want to complement our team. We want to hire staff that give us regular availabilities because that is what our clients want. Our clients want regular staff, that’s why we can provide a tailor-made solution for our clients and their families, and that is what we are providing.

If you’re an intensive care specialist or ICU consultant, we are currently expanding our medical team as well. We want to hear from you, reach out to us here at intensivecareathome.com.

If you’re an intensive care specialist and you have bed blocks in your ICU, I encourage you to eliminate your bed blocks because we can help you do that. But more importantly, we improve the quality of life and sometimes the 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 once again, we can help you eliminate bed blocks in ICU, ED, respiratory wards, 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 info@intensivecareathome.com.

If you’re in the U.S. or in the U.K. or in Canada, please reach out to us we can help you there privately.

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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.