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Pediatric Tracheostomy Care: Why This 2025 Study Falls Short

My name is Patrik Hutzel from intensivecareathome.com, where we provide tailor-made solutions for long-term ventilated, adults and children with tracheostomies, where we provide long-term ventilated adults and children with BIPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure), ventilation at home, tracheostomy care without ventilation, and Home TPN (Total Parenteral Nutrition), home IV magnesium, home IV potassium, home IV antibiotic infusions, central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, port management at home, as well as cough assist management at home, ventilation weaning at home, nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) tube management as well as palliative care at home.

So today, I want to talk about the 2025 American Thoracic Society Clinical Practice Guideline on pediatric tracheostomy care. I’m going to show you exactly why their “evidence-based recommendations” are actually accepting preventable harm as normal and why families with tracheostomy-dependent children deserve far better care than what this guideline proposes and why we, here at Intensive Care at Home, can actually provide that much better and also evidence-based care. Whilst the study is an American study, I see so many parallels to what’s happening here in Australia and in the U.K. as well, but I will come to that in a minute.

So, what the study claims to offer? Obviously, I will link to the study in the written version of this blog so you can look up the study yourself. So, this massive, and “guideline” from the American Thoracic Society published in November 2025, so it’s fresh off the press really, addresses six clinical questions about managing infants and children with tracheostomy.

Number one, ethical principles for tracheostomy decisions, standardized discharge processes, requirements for awake caregivers at home, when to obtain tracheal aspirate cultures, when to perform a bronchoscopy, and role of polysomnography before decannulation. Sounds comprehensive, but here’s what they’re not telling you: The shocking statistics they’re accepting as normal. Let me hit you with the numbers this guideline casually mentions:

Mortality and complications: 9% in hospital mortality within two years of tracheostomy placement, 38.8% tracheostomy-related complications within two years, 17% overall mortality in prospective pediatric studies, 27.5% preventable death rate in children receiving invasive home mechanical ventilation, 10 to 26% mortality rate for children with tracheostomies at home.

If that doesn’t make you shiver, then I don’t know what will. They’re offering no solutions in their study. They haven’t looked at our Mechanical Home Ventilation Guidelines that are evidence-based and that have stood the test of time, but I’ll come to that.

Next, hospitalization burden. 44 to 76% readmission rates within three to 12 months after discharge. Again, that’s completely unacceptable. 47% require four or more emergency department visits or hospitalizations within 24 months. Also, completely unacceptable. $53.3 million total healthcare spending for just 502 children over two years. Again, that’s where Intensive Care at Home can pretty much cut the cost there in half, and keeps children at home and not have these high mortality rates. If anything, we have helped children wean off the ventilator, and get them to decannulate. That’s also $106,000 per child, by the way.

Now, length of hospital stay. Average is 133 to 249 days in hospital after tracheostomy placement. Completely unacceptable. Even with their “improved” standardized discharge process, it’s now 140 days minimum. That’s nearly five months, completely unacceptable. For neonates, it’s 117 to 157 days average length of stay. I mean, I would be embarrassed if I had to publish something like this. These numbers are completely unacceptable. Yet, this entire guideline is built around accepting them as inevitable.

What they barely got right, let’s look at that. I give them credit for a few things. Number one, ethical framework for decision making, they recommend applying for ethical principles (beneficence, non-maleficence, autonomy and justice) to guide shared decision-making about tracheostomy placement. This is good. Families deserve honest conversations about what tracheostomy really means, but having these ethical conversations within a broken system that assumes prolonged hospitalization is inevitable, family caregiver burden is unavoidable, high complication and mortality rates are acceptable, professional 24/7 nursing is “too expensive” or unavailable, complete nonsense and garbage. We are cutting the cost of an ICU bed by 50%. So, to say that 24/7 professional ICU nursing at home is too expensive is complete and utter nonsense. They haven’t done the numbers.

Number two, continuous caregiver supervision. They strongly recommend that an awake and alert trained caregiver always be present with children at risk of immediate decompensation, finally, something sensible, but look at who they expect to provide this 24/7 vigilance: Exhausted family members and parents, under-trained “watchers” with basic training, again, completely unacceptable and also non-evidence-based, overwhelmed parents who can barely get four hours of sleep, whatever nursing support families can cobble together. Spoiler alert: often zero! Again, none of these is evidence-based.

Go and have a look at our evidence-based Mechanical Home Ventilation Guidelines that come out of Germany and out of Australia, and that have stood the test of time since the late 1990s. It’s a gold standard that anybody at home with a tracheostomy plus-minus ventilator needs to have a critical care nurse 24 hours a day, and those critical care nurses need to have a minimum of two years critical care nursing experience similar to an ICU. Why would it be any different? Please tell me why. Leave your comments.

Next, they got right the comments about standardized discharge processes. They suggest implementing a standardized discharge process which showed 42% reduction in length of stay from 249 to 142 days, 43% reduction in direct costs per patient, improved family satisfaction. Hallelujah! Of course, great improvement.

Wrong. Let’s do the math. They’re celebrating reducing hospital stays from 8 months to 5 months at what cost? Pushing under-trained families out the door faster. With what support? The same broken home nursing shortage they acknowledge exists. With what outcomes? Still accepting 9 to 38% mortality and complication rates. It’s just all playing wrong and not well thought through. Celebrating reducing hospital stays from 8 months to 5 months is like 150 years ago, and finally, the cars were invented. If someone would’ve said, “Oh, we need to use a faster horse instead of a car,” it’s a broken model.

Now, the six massive problems this guideline ignores:

• Problem 1: Normalizing catastrophic hospital length of stay.

What they accept is 133 to 249 days average hospital stay after tracheostomy. Standardized discharge reducing these 242 days (5 months), quality improvement project, celebrating 96 to 117 day stays. Again, completely unacceptable and not patient and family focused.

Now, let’s compare that to what we achieve at Intensive Care at Home. Hospital discharge within days to weeks, not months. Professional transition team manages equipment training and set up 24/7 specialized critical care nurses from Day 1 at home. Family can be family, not amateur medical providers.

Let’s do the math. They improved 142-day hospital stay at $3,000 to $5,000 per day is $426,000 to $710,000. Our two to three-week hospital discharge process, $42,000 to $105,000 in hospital costs. Our 24/7 professional home nursing care costs 50 to 70% less than prolonged hospitalization.

• Problem 2: Accepting preventable deaths as inevitable.

The study openly states preventable death occurs in up to 27.5% of children receiving invasive home mechanical ventilation. Again, that is without using the evidence-based Mechanical Home Ventilation Guidelines that we operate under. Root causes include inadequate family caregiver training, improper emergency response and equipment failure. Among 228 children with mortality rate of 21%, 19% of deaths were tracheostomy related. 18.6% of deaths attributed to tracheostomy related complications in another cohort.

They know the causes. Yet, their solution is train families better, create “watchers” with basic training, hope for the best with home nursing shortages; hope is not a strategy, accept these death rates as unavoidable. Once again, it’s completely unacceptable, and the good news is we have a solution here with Intensive Care at Home with evidence-based 24-hour intensive care nursing at home. It’s the gold standard, and we won’t accept anything less here.

Its medical negligence dressed up as clinical guidelines and as a research report. At Intensive Care at Home, we achieve zero preventable tracheostomy-related deaths. Don’t get me wrong. Just because we haven’t had that, the risk is fairly high for us as well. I’m not sugarcoating that the risk that we are taking in the community is reasonably high, but we think we have policies, procedures, but most importantly, we have a team that can make things happen.

We have a wonderful team. If any team members are watching this, I can’t thank you enough for the work that you’re doing every day, all day, every day in sometimes very difficult environments, but we employ hundreds of years of critical care nursing experience combined in the community. It can’t be matched by other providers.

Now, we also have 24/7 professional critical care nurses who can detect problems before they become emergencies, respond immediately with expert intervention, maintain equipment properly, provide continuous professional monitoring, redundant systems with backup equipment, immediate escalation protocols. We have our own intensive care specialist, and we have senior nurses on call.

• Problem 3: The family caregiver burden catastrophe.

The guideline acknowledges devastating impacts on families. Financial devastation, median cost per child $25,000 in the first year alone. Some families exceed $100,000 per child in costs, $1,000 per month in ventilation related out-of-pocket expenses. Median monthly lost wages, almost $10,000 per child. Parents are forced to leave employment or work few hours.

Let’s look at the physical and mental health crisis, poor sleep quality, chronic fatigue, diminished daytime functioning, family strain, gaps in mental healthcare and respite services. The quotes from parents in this study are heartbreaking. Here’s the first quote, “I feel like the financial impact of all this is very difficult. I’m constantly having to fundraise just to supplement, because we only have one income coming in, and there’s no actual funding.”

Another quote says, “Unfortunately, relatives of ours are afraid to take on his care. So, it heavily relies on me and my husband. We have gone without nursing quite a bit, especially during the day.” Another quote says, “I have a major shortage of day nursing.” Another quote says, “If I would’ve been presented with the option of having my income supplemented rather than going back to work and having been my son’s caregiver, that would’ve been an option that we definitely would have considered.”

What is the guideline’s solution? Train families to be amateur nurses, suggest “watchers” with minimal training. Acknowledge the nursing shortage, but accept it as a reality. Recommend paid family caregiving performing “certified” nursing assistant level care. Are you kidding me? It’s barbaric. We’re forcing family to choose between their child’s life, financial ruin, physical and mental health, other family members’ wellbeing, career and livelihood. It’s outrageous. This research paper has absolutely no solutions. They’ve entitled themselves to write a research paper without any solutions. It’s ridiculous. Intensive Care at Home is all about solutions.

• Problem 4: The watcher concept is dangerous.

The study actually suggests training watchers who receive basic training to recognize signs of respiratory distress or need for tracheostomy care. If I was a medical professional, and I would write a research study like that, I would be embarrassed. Let me be crystal here. This is absolutely insane. You don’t need “watchers.” You need a team of professional critical care nurses who can prevent problems before they occur through expert assessments, to not have these sky-high complication and mortality rates, intervene immediately and appropriately when issues arise, manage complex respiratory equipment competently, make clinical decisions in real time based on expertise, monitor continuously with professional judgment, coordinate care with medical teams effectively.

The difference? The “watcher,” something seems wrong, better get the trained family member. Critical care nurse, increased work of breathing noted, secretions building, oxygen saturation trending down, implementing intervention protocol, adjusting ventilator settings, preparing for escalation if needed. See the difference? One is reactive and depends on someone else to fix the problem. The other is proactive, expert and immediately effective.

Now, I can tell you I saw a ventilated client the other day that’s looked after by 24-hour support workers. It’s a ticking time bomb. It’s not a matter of if, it’s a matter of when something will go wrong. I asked the support worker on shift what they would do in an emergency. This is a ventilated tracheostomy client. I asked the support worker what they would do in an emergency, and the support worker said, “Oh yeah, we’ve got this booklet over there somewhere in the corner.” I said, “What if the booklet can’t help you?” “Oh, I’ve got someone that I can call on.” I said, “Well, is that a critical care nurse, or that’s just another support worker?” It is insanity, and people have died under this model. We need to stop it. We have stopped it here at Intensive Care at Home, and we will not be silent about what needs to happen to keep our clients and the wider community safe when it comes to tracheostomy ventilation care at home. Let’s continue.

• Problem 5: The culture management confusion.

Their recommendations on tracheal aspirate cultures, “Don’t do routine surveillance cultures. Do culture during acute respiratory illness. Don’t do test of cure cultures.” Sounds reasonable, but, here’s what they’re missing. They’re operating in a reactive system instead of a proactive system. Their approach, “Wait for the child to get sick, rush to get the culture, start antibiotics.” Maybe appropriate, maybe not. Hope it works.

Readmission rate, 44 to 76% within three to 12 months. That is insanity. You know what I hear from clients every day of the week when I talk to clients, they’re literally begging us to keep them at home, every day when I talk to them. This is what we do, but that’s how important it is to them.

Let’s look at our approach at Intensive Care at Home. Continuous professional monitoring of secretion trends, proactive interventions before infections develop, expert clinical judgment combined with appropriate testing, prevention-focused rather than just treatment-focused result, dramatically reduced infection rates and hospitalizations.

The study admits cultures have limited diagnostic value. Sensitivity – 24.3%, specificity – 85.2%, positive predictive value – 36.5%, negative predictive value – 76.3%. Yet, they still recommend cultures during acute illness. Why? Because they have no better alternative in their reactive system.

• Problem 6: Unnecessary barriers to decannulation.

Their recommendations, complete airway evaluation, bronchoscopy before decannulation, polysomnography or pulse oximetry before decannulation. For those of you that wonder what’s polysomnography, it’s a sleep study. Multiple steps, multiple tests, multiple delays. Don’t get me wrong, safety is paramount, but look at what they’re creating.

Decannulation failure rates in their system, 14% without capped sleep study, 2 to 3% with capped sleep study. But even with sleep study, failure still occurred due to granulomas, multi-level airway collapse. 22% failure rate in one protocol, multiple attempts needed for many children. Why are there such high failure rates? Because they’re using intermittent snapshot assessments instead of continuous professional monitoring.

Our approach, continuous professional assessment by experts who know the patient, progressive trials under professional supervision, individualized assessment based on clinical status, not arbitrary testing, no unnecessary delays waiting for appointments or test results, professional support throughout the transition. Result, higher success rates, fewer complications, less family anxiety.

What’s the real solution? What’s the elephant in the room? The real solution is evidence-based professional Mechanical Home Ventilation Guidelines. Here’s what proper tracheostomy management with home mechanical ventilation actually looks like:

• Phase 1: Rapid hospital discharge planning days two weeks instead of months or sometimes years.

So, not months, we’re talking about days to weeks. Multidisciplinary assessment while still in hospital, professional care team assembly begins immediately, equipment set up and testing coordinated by experts, home environment preparation managed professionally by us, family education focused on collaboration, not becoming amateur nurses, and the focus is on getting our families involved in creating a team so they can help us select nurses they know, like and trust to create a safe and stable team for home care.

• Phase 2: Professional home transition.

Critical care team accompanies patient’s home. 24/7 specialized nursing begins immediately. All equipment is professionally managed. Family integrates gradually at their own pace. No pressure to become medical providers.

• Phase 3: Long-term professional management.

Continuous professional ICU nursing care at home 24/7, 365 days of the year, proactive problem prevention, regular equipment maintenance by professionals, ongoing family support and education, progressive independence facilitated when appropriate and safe.

• Phase 4: Safe decannulation whenever appropriate.

Gradual reduction in support under professional supervision, continuous professional monitoring throughout the process, no arbitrary testing requirements creating delays, and individualized timeline based on clinical progress.

Family remains supported throughout, and I can give you a case in point. We’ve had two pediatric clients in recent years that we not only weaned off the ventilator successfully at home. Then we also kept them at home until they were ready to be decannulated, didn’t need any bronchoscopies. They were just ready to be decannulated. They didn’t need any sleep studies. They were all ready to go. But what’s very important here, those kids are now thriving, which is wonderful, of course. No longer do they need tracheostomy.

I can also give you some horror stories too of our other pediatric clients where in the early days, they didn’t have 24-hour nursing care, we were doing only night shifts there. They actually passed away during the daytime just as we predicted at the time. The NDIS at the time was responsible for those deaths, and still is to this day. So, it’s all about safety. It’s all about evidence-based, and it’s all about preventing those catastrophic failures.

Now, let’s also look at the financial reality check. Let’s compare the real costs. Traditional hospital-based approach per this guideline, hospital costs $53.3 million for 502 children over two years. That’s $106,000 per child over two years. 133 to 249 days average hospital stay at $3,000 to $5,000 per day is $399,000 to $1.245 million per child just for initial hospitalization. Additional family costs out-of-pocket expenses, $25,000 to $100,000 per year. Ventilation expenses, $1,000 per month. Lost parental wages, roughly $10,000 per month median. Annual family financial burden, $140,000 to $220,000.

Let’s look at non-financial costs, parental health deterioration, family strain and possible divorce, sibling neglect, social isolation, mental health crisis.

So, our service really is priceless in the worst way possible. But, Intensive Care at Home approach, hospital discharge, 1 to 3 weeks maximum, $105,000. Rapid professional transition, $10,000 to $20,000. Home care, 24/7 professional critical care nursing, all equipment and supplies included, professional care coordination, family support services. Total cost, 50 to 70% less than prolonged hospitalization.

Next, which is also priceless, family preservation. Parents can maintain employment, $0 lost wages, normal family functioning maintained, priceless. Peace of mind with professional care, priceless. Child at home with quality of life. Do you really want to put a price on that? Because it’s priceless.

Traditional approach, so let’s look at the math. The traditional approach, $106,000 plus hospital, plus $140,000 to $220,000 per year. Family costs $246,000 to $326,000 per year. Our approach, professional 24/7 home care, $120,000 to $180,000 within 6 to 8weeks, savings around $66,000 to $146,000 per year, plus preserved family functioning.

So, what this study gets dangerously wrong? The details. The standardized discharge process, what they recommend? Multidisciplinary team, comprehensive family effect, comprehensive family caregiver training, community education, staged educational approach. Sounds good until you see what they’re actually training families to do. From their Table 2 in the study, they expect family caregivers to master understanding and use of all devices and equipment, routine tracheostomy and respiratory care, day-to-day respiratory management and troubleshooting, emergency care, medication administration, simulation of airway emergency.

This is a four-year critical care nursing degree crammed into a few weeks of someone who hasn’t done a nursing degree. Even worse, they admit single parent family struggle with this. Families lacking second caregivers face challenges. Social determinants of health impact discharge timelines, but they pushed ahead anyway.

Let’s also look at the ethical framework hypocrisy. They recommend applying ethical principles (beneficence, non-maleficence, autonomy and justice to guide decisions), but look at the real choices they’re offering families. Option A: Don’t do tracheostomy. Let the child die, or remain in hospital indefinitely. Option B: Do a tracheostomy with their flawed model. Five to eight months in hospital minimum, family becomes amateur nurses, financial devastation, 9 to 38% mortality complication rate, physical and mental health crisis. Hope you can find some nurses at home. Spoiler alert! You probably can’t. Is this real “autonomy?” Is this real “justice?” No, this is presenting two terrible options, and calling it shared decision-making.

A real ethical conversation would include Option C, professional home mechanical ventilation with Intensive Care at Home, because we’re talking about rapid discharge home days to weeks, 24/7 professional critical care nursing. Family remains family, near zero preventable complications, financial sustainability for everyone including the hospitals, quality of life preserved. But, this guideline never even mentioned this option.

Also, they’re talking about the home nursing shortage excuse. Throughout this guideline, they repeatedly mentioned the home nursing shortage as if it’s an unchangeable fact of nature, but then they admit the real reasons for the shortage, inadequate training, non-competitive pay, limited benefits, greater demand. Another reason they also haven’t mentioned is the lack of advocacy.

So, the problem is absolutely solvable, but they accept it as inevitable. At Intensive Care at Home, we pay competitive wages to attract top talent. Number two, we provide comprehensive training and ongoing education. We offer excellent benefits, and we create what we believe are sustainable working conditions. We have a very low staff turnover. Result, we have the nursing staff because we invest in our nursing staff.

The nursing shortage isn’t a natural disaster. It’s

Next, the bronchoscopy recommendations, they recommend bronchoscopy for symptomatic changes. Strong recommendation for complete a policy choice and a resource allocation failure and also a lack of creativity, because the hospitals are not creative to think outside of the box to create what needs to happen for these families. Airway evaluation before decannulation, and here’s what they found. 55 to 87% of children had airway lesions. 26 to 58% had a required intervention, but only 23 to 48% were symptomatic before bronchoscopy. So, here’s the problem. They’re using bronchoscopy as a screening tool because they don’t have continuous professional assessments. In our model, critical care nurses monitor continuously, early changes are detected and addressed, and problems are prevented before they require procedures. When bronchoscopy is needed, it’s truly indicated not just screening.

Their approach, let’s scope everyone before decannulation because we might miss something. Our approach, our nurses know this patient intimately. If there’s a concern, we address it proactively.

Let’s look at the polysomnography debate or the sleep study debate. They suggest either sleep study or pulse oximetry before decannulation, but look at their own data. Sleep study is resource and cost intensive. Sleep study may delay decannulation. Even with reassuring sleep studies, success isn’t certain. Sleep study provides false reassurance, and there’s a limited access globally. Post comparison they provide, sleep study in the U.S. is $3,075. Hospital admission with overnight oximetry is $2,808 per night.

So why even the debate? Because in their model, they’re doing intermittent snapshot assessment instead of continuous professional monitoring. Our approach at Intensive Care at Home is continuous professional monitoring during trials, progressive assessment under expert supervision, real-time clinical decision-making, no arbitrary waiting for appointments, better outcomes, less cost, less family burden.

Now, let’s look at the evidence they’re ignoring. The research paper completely ignores or minimizes evidence showing that early discharge with professional support is actually superior. Multiple studies show early discharge with adequate support reduces complications, home environments promotes development and healing, family integration improves outcomes, professional 24/7 critical care nursing care achieves better safety metrics.

Next, continuous professional care beats intermittent assessment any day of the week. Evidence demonstrates that continuous monitoring detects problems earlier. Prevention is more effective than treatment, professional expertise prevents complications, family functioning is preserved with professional support.

The true cost-effectiveness of professional home care, let’s look at this. Studies consistently show professional home care costs less than prolonged hospitalization, quality of life improvements have economic value, family employment preservation has economic value, reduced emergency utilization offsets nursing costs. The mortality rates do not have to be this high. International data shows programs with adequate professional support achieve near zero preventable deaths.

That’s what we’ve been doing here at Intensive Care at Home. Proper equipment and monitoring prevents most complications. Once again, we’ve been doing this with Intensive Care at Home since 2012. Professional expertise is the key variable. Family training alone is insufficient and lethal, but this guideline ignores all of this to fit their predetermined conclusions.

Now, what families actually need to know? If you or your loved one needs a tracheostomy and mechanical ventilation, here’s what you actually need to understand. What you don’t need, despite what the guideline says:

• 4 to 8 months trapped in a hospital,
• To become an amateur critical care nurse,
• To sacrifice your career and financial security,
• To live in constant fear of emergencies you are not qualified to handle,
• To accept 9 to 38% mortality and complication rates as “normal,”
• To fundraise to keep your family afloat financially,
• To choose between your child’s life and your family’s well-being,
• To rely on “watchers” with minimal or no training,
• To hope home nursing becomes available. It probably won’t in their system.

It’s available here with Intensive Care at Home. So, what you deserve and can actually have:

• Rapid discharge home with proper professional support days to weeks, not months,
• 24/7 specialized critical care nursing by trained professionals,
• To be a parent, family member and not a medical provider,
• Peace of mind knowing experts are monitoring continuously,
• Near zero preventable complications through professional care,
• Financial sustainability and preserved employment,
• Quality of life for your entire family,
• Professional coordination of all care aspects,
• Proactive problem prevention, not just reactive treatment,
• Real choices based on evidence-based care models.

The questions you should be asking your medical team, if you’re being told your child needs months in hospital after tracheostomy or that you need to become the primary caregiver with basic training, ask, “Why can’t we go home with professional 24/7 Intensive Care at Home nursing support?” If they say it’s too expensive, ask them to compare, 5 to 8 months in hospital at $5,000 to $6,000 per bed day or professional home care for 24/7 care for half of the cost.

Then ask them, “What would it take to discharge within two to four weeks instead of months?” If they say, “We need time to train the family,” that’s your red flag there and then, and that they’re planning to make you the primary medical provider. Tell them, “We have staff available pretty quickly, and they’re all trained.”

Ask them, “Why am I and my family being trained to do what a specialized critical care nurse should be doing and is qualified and trained to do so?” If they say because of the home nursing shortage, ask why they’re accepting that as inevitable rather than solving it. Ask them to talk to us. We don’t have a critical care nursing shortage in the home. We can supply staff to our clients.

Ask them, “What are your actual mortality and complication rates for children with tracheostomies?” If they quote rates anywhere near the 9 to 38% range from this study, run! That’s unacceptable.

Next, “Have you considered professional home-based care with 24/7 specialized nursing with Intensive Care at Home?” If they say that doesn’t exist or insurance won’t cover it, they’re wrong. It does exist, and it is often covered because it costs less than prolonged hospitalization. All of our clients have 24-hour nursing funding through NDIS or other funding bodies.

Next, “Can you guarantee my child will have home nursing when discharged?” Watch them squirm on this one. They can’t guarantee it because in their model, it usually doesn’t materialize. But in our model, it does materialize.

“What happens if I can’t handle the medical care you’re training me to provide?” If they say, “We’ll readmit to a hospital,” that’s admission that their model doesn’t work. Come to us and we will prove to you that you don’t need to go back to hospital.

The bottom line, this guideline promotes and perpetuates harm. This 2025 American Thoracic Society Guideline represents incremental improvements within a fundamentally broken system. I can tell you the system is the same in Australia or in the U.K. It doesn’t matter, it’s in all English-speaking countries, it’s the same. They’re making excuses, and they’re not following what’s evidence-based guidelines, because they’re accepting unacceptable mortality rates, 9 to 38%, normalizing catastrophic hospital lengths of stay, 133 to 249 days, forcing families into impossible caregiver roles, ignoring the evidence for professional home-based care, which is everything that we do at Intensive Care at Home.

They’re creating false “ethical” choices that aren’t really choices at all. They’re accepting preventable deaths as inevitable up to 27.5%, and they’re perpetuating financial devastation of families, and they’re missing the proven alternative care model like Intensive Care at Home.

Meanwhile, the evidence is clear that professional Home Mechanical Ventilation Guidelines with specialized nursing is superior and it achieves better outcomes, near zero preventable deaths, lower costs, 50 to 70% less than prolonged hospitalization, higher family satisfaction and quality of life, preserved family functioning and employment, maintain patient dignity and development, proactive prevention rather than reactive treatment.

Take action now! If you or your loved one is facing tracheostomy and mechanical ventilation decisions, whether you’re adult or child, doesn’t matter, don’t accept the broken models this guideline promotes. Contact us at intensivecareathome.com. Call us on one of the numbers on the top of our website, or send us an email to [email protected], because we provide expert consultation on your specific situation.

We coordinate with your medical team. You get professional 24/7 intensive home care nursing, rapid discharge planning and execution, family support and education as collaborators, not medical providers, quality of life for patients and families, evidence-based care that achieves actual results. We also help you with the advocacy to get the funding. Otherwise, we would not exist.

Go and check out our evidence-based Mechanical Home Ventilation Guidelines, because this comprehensive guideline shows you what proper home mechanical ventilation actually looks like, questions to ask your medical team, red flags in proposed care plans, how to advocate effectively for better care, the evidence supporting professional home-based care, financial realities and insurance or funding coverage, family rights and options, and how to avoid the traps this guideline creates. Also, join our email newsletter, and subscribe to my YouTube channel.

Final thoughts. Look, I understand this guideline was written by well-meaning professionals trying to improve care within the system they know, but better isn’t good enough when best is available and proven, and best is Intensive Care at Home, because families facing tracheostomy decisions for their children deserve complete and honest information about all options, access to evidence-based professional home care, like Intensive Care at Home, financial sustainability, preserve family functioning, safety and peace of mind, quality of life for everyone involved.

Because the guideline, let’s call it for what it is, fails on every single one of these metrics. Instead, it perpetuates a broken model, accepts preventable harm as normal, forces families into impossible situations, and ignores proven alternatives, and it creates false ethical choices, prioritizes system convenience over patient and family well-being.

Don’t let anyone tell you that months in hospital are necessary, or that you must become your child’s or your family member’s nurse. Financial devastation is inevitable, or that 9 to 38% mortality complication rates are acceptable, and that the home nursing shortage can’t be solved, and that professional 24/7 home care doesn’t exist. All of these are false claims. There is a better way, and it’s evidence-cased, proven and available.

Remember, you are your child’s best advocate or your family member’s best advocate. Don’t let institutional inertia, system limitations, limited thinking or outdated guidelines trap your family in a model that causes preventable harm. Come to us, professional home ventilation with 24/7 intensive care nurses at home is available. It’s evidence-based. It’s cost-effective, superior in outcomes, and your right to pursue.

Contact us today at intensivecareathome.com. Call us on one of the numbers on the top of our website, or send us an email to [email protected].

Now, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24 hours a day. We are providing the following:

• Home care services for ventilated adults & children with tracheostomies with critical care nurses 24 hours a day
• Genuine alternative to a long-term stay in intensive care or at long-term acute care
• Tracheostomy care for clients without ventilation
• Home care services for patients on non-invasive ventilation such as Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure)
• Home TPN (Total Parenteral Nutrition), which is also known as IV nutrition
• Home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics
• Providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home.
• Providing nasogastric tube and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home
• Use cough assist machines for our clients for airway clearance at home
• Palliative care services at home
• Ventilator weaning 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, saving approximately $2,000 per patient that we keep at home, instead of them going to an emergency department.

That also means, we’re also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs between $5,000 to $6,000 per bed day. Our services 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. Most importantly, we’re improving the quality of life for patients and their families, which is a win-win situation for all stakeholders. Of course, quality of life is much improved surrounded by families and by a team of dedicated intensive care nurses in the home care setting instead of in an intensive care unit.

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 work with NDIS (National Disability Insurance Scheme) clients all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, Department of Veteran Affairs (DVA) 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 having policies and procedures for Intensive Care at Home nursing and we’ve built all the intellectual property for Intensive Care at Home since 2012. No other provider in Australia 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, or you’re stuck in an ICU long-term, or if you’re going to the hospital and ED all the time, and you realize that you don’t have the right level of support at home, or if you are stuck in an ICU, I’ll give you a real-world example today, how we can help you.

One of our first clients when we first got started in 2012, was a client who was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers are not equipped to look after a client at home on a ventilator with a tracheostomy. That is dangerous and it’s simply negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy is like flying the airplane with a cabin crew instead of the pilot. Because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies 24/7, or even at high risk of dying if they don’t have a team of dedicated critical care nurses looking after them 24/7 at home. This is actually evidence-based and is documented in our Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com.

Think about it, in an intensive care unit in a hospital, you wouldn’t have support workers looking after your critically ill loved one or after any critically ill patient on a ventilator with a tracheostomy. So, why would anyone in their right mind do that in the home care environment in the community?

So, this client at the time found out about us eventually, and the ICU that he was basically living in also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with this particular client, we sent him critical care nurses, 24 hours a day. He never ever went back into ICU ever again, as long as we were working with this client.

We can do the same for you if you’re not safe at home and help you with keeping you at home predictably. Otherwise, we would not be in business. Again, the same is applicable for those stuck in an ICU, similar to this case study that I’ve just given you, or if you’re going back to ED all the time, please reach out to us. We can help you with taking you through the right steps, including how to get funding with different funding bodies.

This is also why we are providing 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. 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 need more evidence for nursing care, we are also writing NDIS nursing assessments with legal nurse critical care consulting nurses.

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’re employing hundreds of years of critical care nursing experience combined. You can join this high performing team if you are a critical care nurse.

If you are looking for a career change as a critical care nurse, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, 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 do have a disclaimer though, 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 so vulnerable and so special. 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 availabilities for shifts, and you’re really keen on building solid relationships with us and with our clients.

If you’re 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.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, or for 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. and 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 or 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.