Hello and welcome to another Intensive Care at Home live stream. Today we are covering the topic: sepsis survivor on a ventilator — what comes next and can they come home?

I also want to thank all of our viewers watching this on replay. I know we have viewers from the US (United States), Canada, and the UK (United Kingdom), and I want to welcome all of our international viewers as well.

At Intensive Care at Home, we provide tailor-made solutions at home for long-term ventilated adults and children with tracheostomies with 24/7 CCRN (Critical Care Registered Nurses). At home, we provide tailor-made solutions for long-term ventilated adults and children on BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure) without tracheostomy with 24-hour critical care registered nurses at home. We provide tailor-made solutions for adults and children with tracheostomy without ventilation at home — also with 24-hour critical care registered nurses at home. We also provide ventilation and tracheostomy weaning whenever medically appropriate, also with 24/7 critical care registered nurses, cough assist management at home, home TPN (Total Parenteral Nutrition), home IV fluids, home IV antibiotics, potassium, magnesium and other electrolyte infusions at home — which goes hand in hand with central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line, and port management at home. We also look after PEG (Percutaneous Endoscopic Gastrostomy) and PEJ (Percutaneous Endoscopic Jejunostomy) tubes at home, nasogastric tube and nasojejunostomy tubes at home, and also IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home. We also provide palliative care services at home when appropriate, and we also provide Level 2 and Level 3 NDIS (National Disability Insurance Scheme) support coordination as well as TAC (Transport Accident Commission) and WorkSafe case management.

A quick note before we start: everything I share today is general information. It is not personal medical advice and it does not replace your treating team. If you have a very personal question, I will show you at the end how to get one-on-one help, because I do not want to give you a half answer in a chat box. If you do have any questions, type them in and we do a questions and answers towards the end.

Before I go any further and do a deep dive into today’s topic, you might be wondering what makes me qualified to talk about topics such as today’s. I have worked in critical care nursing for over 25 years in three different countries where I worked as a nurse manager in ICU (Intensive Care Unit) for over five years, and I started Intensive Care at Home in 2012 in Australia. Before that, I had significant hands-on experience with intensive care at home services in Germany in the early 2000s, where I was part of a pioneering intensive care at home service — Brambring and Jaschke in Munich. Big shout out to Jürgen and Kristof. I then worked in ICU in the UK and in Australia and could see patients in ICU that we would have looked after at home in Germany — and I obviously saw a big unfilled need for this market.

The Question I Hear Over and Over Again

My loved one survived sepsis. The infection is gone, but they are still on a ventilator with a tracheostomy. The hospital is talking about rehabilitation. Sometimes they are talking about end of life care. Sometimes they cannot make up their mind what is next. Sometimes they are talking about a long-term stay in intensive care.

If that is you, I want you to know something first. You are not alone in this journey. You are not wrong to be confused. You are not wrong to ask the right questions, because this is one of the hardest places a family in intensive care can find itself. The immediate crisis seems to be over, but the ventilation and the tracheostomy are still there — and nobody has drawn you a map of how to move forward, or given you options besides probably three: stay in ICU for long periods of time and look at ventilation weaning if that is possible; look at rehabilitation; or withdrawal of treatment. If none of those options seem appealing, then you have come to the right place — because that is when Intensive Care at Home might be an option.

Here is the road map for today. First, I will explain what is going on clinically. Second, why some people can and others cannot come off the ventilator. Third, treatment options. Fourth, what our evidence-based Mechanical Home Ventilation Guidelines say about going home. Fifth, a warning example. Then we talk about access to medical records, how to get expert help, our Intensive Care at Home long-term model, your questions, and why third-party accreditation matters when it comes to intensive care at home.

I also want to quickly highlight that Intensive Care at Home was designed as a genuine alternative to a long-term stay in intensive care. You get the same level of care at home as you do in an ICU — with 24/7 critical care registered nurses and medical oversight.

My ICU career started in Germany, where home ventilation is now an established part of homecare nursing and intensive care. I have seen how well it can work when it is done properly, and we have certainly shown that here in Australia since 2012. It is clinically safe, it is evidence-based, and it is third-party accredited. When I worked in the UK and came to Australia in 2005, I saw how many families were stuck between an ICU bed and no safe option at home — stuck between withdrawal of treatment and no options. That very gap is what led me to found Intensive Care at Home in 2012. Every live stream and every blog post I put out is about closing that gap — and it is really driven by you, the audience, because I get your questions. I want families in intensive care to make informed decisions, have peace of mind, control, power, and influence, so that your loved one always gets the best care and treatment in intensive care and then outside of intensive care when it is time to go home with Intensive Care at Home.

The Clinical Picture: What Happened and What Does Ventilator-Dependent Mean?

Let us start with sepsis. Sepsis is a life-threatening condition where the body’s response to an infection starts to damage its own organs. It can start as a chest infection, a UTI (Urinary Tract Infection), an infected wound, an abdominal problem, or anything really.

In severe sepsis, three things can happen together. The blood pressure usually drops dangerously low — that is what we know as septic shock — and it often needs medications to hold the pressure up, such as vasopressors and inotropes like noradrenaline (norepinephrine), adrenaline, vasopressin depending on whether the heart is weak, sometimes dobutamine or milrinone and so forth. The organs like the kidneys can struggle or even shut down. And the lungs can become inflamed and stiff. When that lung injury sets in and is severe, we call it ARDS (Acute Respiratory Distress Syndrome) — it can also be labelled as lung failure.

When the lungs cannot do their job, we put the patient on a mechanical ventilator in ICU, usually with sedation such as propofol, midazolam, fentanyl, morphine — sometimes Precedex or dexmedetomidine — sometimes for days, sometimes for weeks. Sometimes patients are even paralysed with paralyzing agents. For most families, that is a life-saving thing. Surviving sepsis and the ICU is a genuine achievement. But here is what people do not tell you. Getting through sepsis is one battle. Getting off the ventilator is a second battle. And for some people, it is a long battle.

If you have been at the bedside, you know what the ICU looks like — the noisy alarms, the tubes, the lines, the machines. In the first days, the ICU team is focused on finding and treating the source of the infection, giving antibiotics, supporting the blood pressure, and supporting the organs. Sedation is often used so the patient tolerates the breathing tube and the machine. Once the infection is under control, the team starts to ask a different question: can the lungs and the muscles do this on their own yet? The sedation is lightened and the patient is woken up. And for some people, that is when the second battle begins. Some wake up confused or frightened — that is ICU delirium or ICU psychosis — and it is unfortunately very common in ICU. Some wake up so weak they cannot lift an arm or cough properly. And this is where a lot of families get blindsided, because they expected that once the infection cleared, recovery would be quick.

Ventilator-dependent means a person needs machine support to breathe — either for part of the day or all day. Invasive ventilation is delivered through a breathing tube initially and then a tracheostomy in the long term. Non-invasive ventilation is delivered through a mask — that is what we call BiPAP or CPAP. Both can be used at home when the conditions are right and stable, and both need skilled 24/7 critical care registered nurses.

When somebody is on a ventilator for a long time — generally three weeks or more — we call it PMV (Prolonged Mechanical Ventilation). That is usually the point where the ICU team starts talking about a tracheostomy.

I want to clear up a big misunderstanding. A tracheostomy is not the end of the road for a lot of people. It is a bridge. It can mean less sedation, easier clearing of secretions, better mouth care, and a better platform for weaning, rehabilitation, and mobilization. In some patients, a speaking valve can allow them to talk again once the team has assessed it is safe. But a tracheostomy tube is the patient’s airway — it needs to be looked after by people with the right skills and the right training. A ventilator and a tracheostomy — either or, or the combination of both — need 24/7 critical care registered nursing skills. That is why your loved one is in ICU right now.

Outdated ICU Paradigms and the Third Proven Option

The outdated ICU paradigm has been as follows: a patient in ICU has two options. The first is to improve, recover, and go to a hospital floor or ward. The second is to pass away and not leave ICU alive. That is a very black-and-white and outdated model — which is why we created a third proven option, which is to go home with Intensive Care at Home with long-term ventilation and tracheostomy, ventilation without tracheostomy, or tracheostomy without ventilation. We have created a genuine alternative to a long-term stay in intensive care.

Why Can’t Some Sepsis Survivors Come Off the Ventilator?

There is rarely one single reason. Here are the common ones.

Number one: Breathing muscle weakness. The diaphragm is our main breathing muscle. When a machine does the work for days or weeks, the diaphragm can lose strength surprisingly quickly. That is one of the reasons weaning is gradual. Two things are gradual in ICU — waking up after an induced coma, and weaning off the ventilator — especially for long-term weaning patients. It is a step-by-step process that often does not happen quickly.

Number two: ICU-acquired weakness. Severe illness, inflammation, immobility, and sedation can weaken the whole body. We call it critical illness myopathy and polyneuropathy — that includes the muscles needed to breathe and to cough. Does sedation for 20 days cause damage? That is exactly what I have just covered here.

Number three: Lung injury. After ARDS, lung failure, or severe pneumonia, the lungs can take a long time to recover. Some people are left with reduced lung function.

Number four: Secretions and a weak cough. If you cannot clear mucus, the lungs clog, oxygen drops, and the effort of breathing goes up. This is a big reason people fail spontaneous breathing trials. A weak cough comes back to sedatives and opiates for many days, sometimes even weeks.

Number five: Swallowing problems. After a long time with a breathing tube, swallowing can be unsafe, which raises the risk of aspiration and pneumonia.

Number six: ICU delirium or ICU psychosis, exhaustion, and PICS (Post-Intensive Care Syndrome). PICS is the physical, cognitive, and psychological problems that can follow critical illness — including PTSD (Post-Traumatic Stress Disorder). The post-traumatic stress affects families too. If you feel exhausted and overwhelmed, that is normal. That is perfectly normal.

Number seven: Existing conditions and frailty. Pre-existing heart, lung, or neuromuscular conditions make weaning off the ventilator much harder.

Here is another reason why there is often a delay in waking up and coming off the ventilator. Many patients in ICU during sepsis go into kidney failure, sometimes even liver failure. If that is the case, there is often a delay in sedatives, opiates, and sometimes paralyzing agents leaving the body system — which means there may have been sedation and opiates for many days and the patient is still not waking up or moving forward, because the kidneys and liver are not in a position to clear them yet — delaying waking up, making the muscles weaker, and so forth.

The point is this: when somebody remains on a ventilator after sepsis, it is usually not because someone gave up. It is because recovery from critical illness takes time, and some bodies need more support for longer than others.

Imagine a person whose diaphragm has weakened, whose cough is weak, who has thick secretions and a swallow that is not safe yet. Each one alone might be manageable. Together, they make it very hard for that person to breathe unaided for hours at a time. And when they get tired or a chest infection starts, they need the machine again.

This is also why I see what I call the bounce. A patient is stable enough to leave ICU. They go to a ward or to rehab. Then they have a chest infection, a mucus block, or exhaustion sets in — and back they go to ICU. Families tell me it feels like a merry-go-round. Often the missing piece is not more time in a hospital or ICU bed. It is a plan for the right long-term care — delivered by whom and to what standard — and that is when I come to Intensive Care at Home.

Please do not blame yourself. Please do not blame the treating team either. Sepsis in ICU is one of the most serious conditions we see. The mortality is very high. The people who survive it often have been through more than any of us can ever imagine. Recovery is measured in weeks and months, not days.

Treatment Options and What Comes Next

Every person is different and the treating ICU and respiratory team decide what is right. But in general there are five pathways.

Number one: Active weaning. Gradually reducing machine support and increasing time breathing with less help, alongside physiotherapy, nutrition, and rehabilitation. Many sepsis survivors do come off the ventilator. This should always be properly explored first and documented.

Number two: Tracheostomy without ventilation. Some people no longer need the ventilator but still need the tracheostomy for airway protection or secretion management. They still need 24/7 skilled tracheostomy care with critical care registered nurses — whether that is in an ICU or at home with Intensive Care at Home. A tracheostomy without a ventilator is not a low-risk situation. The airway can still block or move — hence the need for 24/7 critical care registered nurses in ICU or at home with Intensive Care at Home.

Number three: Transition to non-invasive ventilation. Some people can move from a tracheostomy to mask-based support such as BiPAP or CPAP — often at night or even as prescribed intermittently day and night.

Number four: Long-term invasive ventilation with tracheostomy. For people who remain ventilator-dependent after weaning has been fully explored. This is an established treatment and home is an option if the right conditions are met.

Number five: Palliative or end of life care. Some families together with the doctors and the patient make a comfort-focused choice based on the patient’s wishes. That care can also be provided at home.

Running alongside all of that are cough assist machines, speech pathology, respiratory physiotherapy, dieticians, social workers, and potentially NDIS support coordinators or case managers as well.

A Deeper Look at Weaning

Weaning is not switching a machine off. It is a structured process. The team reduces the amount of support the machine gives, or tests the person for short periods off the ventilation machine — for example, breathing through the tracheostomy with humidified oxygen only. Those periods get longer as the person gets stronger. If the person gets tired, the team goes back a step, rests the patient, and tries again. A setback is not a failure. It is part of the process.

Alongside that, the team looks at the whole person. Are they getting enough nutrition to rebuild muscle? Is the physiotherapist getting them out of bed, sitting up, standing? Is speech pathology checking the swallow and whether the cuff on the tracheostomy can be let down and a speaking valve trial attempted? Speaking valves are a big moment for families because hearing your loved one’s voice again can change everything — but they are not suitable for everyone and must only be used when the team has assessed that it is safe.

For patients who cannot cough effectively, a cough assist machine helps clear secretions. It gently inflates the lungs and then pulls the air and mucus back out. It is a standard tool in home ventilation care and needs to be used by someone trained in it — which is our critical care registered nurses.

For some people the goal is to move from a tracheostomy to a ventilation mask — non-invasive ventilation such as BiPAP or CPAP — often used at night, for parts of the day, or night and day. Our guidelines list failure to transfer to non-invasive ventilation after invasive ventilation as one of the situations where a tracheostomy might be indicated — always with informed consent and the wishes of the patient.

Home ventilation is not a new or experimental idea. In countries like Germany where I trained initially, it has been standard for decades. Germany, Austria, Switzerland, and now Australia are the leading countries in this. That is why we publish the evidence-based Mechanical Home Ventilation Guidelines that you can find on our website at intensivecareathome.com. Those evidence-based guidelines are a result of over 25 years of intensive care at home nursing in Germany, Australia, Austria, and Switzerland.

Can They Come Home? What the Evidence-Based Guidelines Say

The Mechanical Home Ventilation Guidelines draw on published international guidelines, including the German S2 guideline for non-invasive and invasive ventilation in chronic respiratory failure, and the American Association for Respiratory Care guidelines on long-term invasive ventilation in the home — all with 24/7 critical care registered nurses. Here are the highlights in plain English.

First: The move from ICU to home is a highly vulnerable phase. The right time to go is when the illness is stable and the funding, equipment, resources, and care team are secured — not before that.

Second: Invasive ventilation with tracheostomy needs skills that are generally critical care nursing skills 24/7. Ventilation settings should only be changed on a doctor’s orders and carried out by critical care trained registered nurses present with the patient 24/7, 365 days of the year.

Third: The equipment. If ventilation goes beyond 16 hours a day, you need a second identical ventilator and an external battery pack. You need a humidifier for invasive ventilation, a reserve tracheostomy tube and a smaller reserve tube for emergencies, a high-performance suction unit and a backup unit, and a backup power supply.

Fourth: The team. The guidelines prescribe 24/7 critical care registered nurses with at least 18 months of ICU nursing experience, ideally with a postgraduate critical care nursing qualification. At Intensive Care at Home, we do 24 months minimum ICU experience. Over 50% of our critical care nurses have completed an ICU postgraduate certificate or higher — so that ventilation parameters can be monitored, interpreted, and documented at least once per hour.

Can a Sepsis Survivor on a Ventilator Come Home?

Sometimes yes. And when it is done properly, it can be a genuine alternative to a long-term stay in intensive care with Intensive Care at Home. Here is a checklist.

Number one: The acute illness is stable and the medical team agrees the person is ready to go home with 24/7 critical care registered nurses with Intensive Care at Home.

Number two: Weaning and rehab have been properly explored and documented.

Number three: The ventilator, the backup, the batteries, the suction, the humidification, the spare tubes, all the emergency equipment and monitoring equipment are in place, and the home is safe.

Number four: Funding is confirmed before discharge. An intensive care bed costs $5,000 to $10,000 per bed day. Intensive Care at Home approximately costs half of that. Any funding body will have an interest in supporting this.

Number five: A team of critical care registered nurses is rostered 24 hours a day in the person’s home. Families are consulted on the team that is starting and have been involved in the staff selection process. They are not left to carry a clinical load they have never signed up for and are not equipped to carry.

There is one more thing specific to sepsis: sepsis survivors are at higher risk of getting sick again in the months after discharge. Having 24/7 nurses with ICU-level training who recognise early deterioration — changes in secretions, temperature, heart rate, oxygen levels, or alertness — is a big deal. Early recognition and action can prevent a readmission back into ICU and worse.

Two more points from the evidence-based Mechanical Home Ventilation Guidelines:

Humidification: For anyone ventilated through a tracheostomy, the guidelines describe humidified air as essential, delivered at body temperature — 37 degrees — with research showing it reduces the risk of VAP (Ventilator-Associated Pneumonia).

Technical support: The equipment provider must be contactable around the clock and a technician must be available within 24 hours if there is a problem with the ventilator or any other life-saving equipment.

Five Questions to Ask the Hospital This Week

Number one: What are the specific reasons this person is still on the ventilator and what has been tried so far?

Number two: Has weaning been properly explored and is that documented?

Number three: What is the plan if the person cannot come off the ventilator or the tracheostomy, and has a home option with 24/7 critical care registered nurses been assessed?

Number four: What would need to be in place for discharge — equipment, funding, training, and the nursing team?

Number five: Can I have a copy of the medical records — including weaning charts, tracheostomy details, doctor’s notes, nursing notes, vital sign charts, pathology results, medication chart, CT scan results, MRI scan results, chest X-ray reports, fluid balance charts, neurological assessment tools, speech pathology and physiotherapy assessments, OT (Occupational Therapy) and FCA (Functional Capacity Assessment) reports, MDT (Multidisciplinary Team) meeting notes, and any goals of care discussions? Leave no stone unturned.

The Alternative to Intensive Care at Home

A long-term ICU bed or long-term hospital bed — maybe on a respiratory ward if you are lucky — or a long-term facility, is very stressful and very expensive. Our evidence-based Mechanical Home Ventilation Guidelines say home ventilation, while not as cost-effective as typical hospital-in-the-home services, is by far more cost-effective than a prolonged intensive care stay. That matters to funding bodies, and it matters to families who want their loved one in a familiar, quiet, private, dignified environment where they can live with privacy and dignity.

Four Myths I Hear All the Time

Myth number one: Tracheostomy means there is no hope. Not true. For many people it is a bridge that makes weaning and rehabilitation easier. For most of our clients living with a tracheostomy, it is their lifeline and they want to be alive.

Myth number two: If the hospital says no to home, that is final. Not necessarily. Ask for the clinical reasons in writing. Ask what would need to change, and ask whether a home option with 24/7 critical care registered nurses has been assessed. We also cannot provide services against medical advice — but what we can do is organise an intensive care specialist or other clinical governance that enables a patient to go home safely if the hospital is reluctant.

Myth number three: The family can just do it with a little bit of help and training. Families are wonderful and they are part of the team, but no family should be left carrying an intensive care clinical load they never signed up for. Our evidence-based Mechanical Home Ventilation Guidelines describe the care team as 24/7 critical care trained nurses working alongside the patient and the family in their own home — from over 25 years of intensive care at home nursing in Germany, Austria, Switzerland, and Australia.

Myth number four: Home is always the best option. Not always. Home is the right option when the person is stable, the equipment and funding are secured, and the right team is in place. Otherwise, it can be unsafe — and I would rather tell you that right now.

Three Situations That Need 24/7 Critical Care Nurses — and a Warning Example

There are three situations where 24/7 critical care nurses are needed at home:

• Invasive ventilation with tracheostomy
• Non-invasive ventilation on BiPAP or CPAP
• Tracheostomy care without ventilation

Because all of those patients are usually in ICU. Think of flying an airplane with the cabin crew instead of the pilot. You would not get on that airplane if you knew that was the case.

This is why the work at home needs to be done with 24/7 critical care registered nurses — not with disability support workers, not with enrolled nurses, not with general registered nurses without ICU experience — because patients have died when downgrading from 24/7 critical care registered nurses. I have great respect for general registered nurses, enrolled nurses, and disability support workers. But when someone goes home on a ventilator with a tracheostomy, on ventilation without tracheostomy, or with tracheostomy without ventilation, and something happens at 3:00 a.m. and the airway is at risk — you need the pilot in the cockpit, not the cabin crew. Someone trained to assess, decide, and act within minutes, if not seconds. In my clinical view and in our evidence-based Mechanical Home Ventilation Guidelines, that person is a critical care registered nurse 24 hours a day — nothing less than that.

Now a quick warning example. I say this with respect for Noah Johnston and his family. Noah’s case is one I keep coming back to because of what it shows. In December 2025, Noah’s tracheostomy tube became displaced at a time when no registered nurse was present. The NDIS at the time cut the funding from 24-hour critical care registered nurses to 12 hours a day. Just as I said, disability support workers did not know what to do. And as reported in the Daily Telegraph, Noah died. A tracheostomy tube is an unstable airway. When it moves, minutes or seconds matter. The person in the room needs to know how to respond and have the right equipment right there. That is critical care nursing training, experience, and skill.

I am not saying every situation ends like that. I am saying that this is exactly the type of event critical care registered nurses are there to recognize, manage, and prevent in the first place. So when you are looking at a care plan for a loved one with a tracheostomy, ask the hard questions: who is in the room, what are they trained to do, and what happens at 3:00 a.m.?

Medical Records: The Most Powerful and Most Overlooked Tool

Whether your goal is going home, an NDIS application, TAC, WorkSafe, DVA (Department of Veterans’ Affairs), or simply understanding what happened — the medical record tells the story. As the patient or their authorized representative, you generally have the right to access it — usually through the hospital health information or medical records department.

Build a timeline, and if you spot a gap or something that looks wrong, raise it in writing through the proper channels. Never alter a record. The reason this matters is that funders — whether NDIS, iCare, WorkSafe, DVA, private health funds, or departments of health — want to see what care is clinically necessary. Accurate, complete records let them see it.

You do not have to work this out on your own. If you need advocacy in ICU, we also provide consulting and advocacy for families in intensive care at intensivecarehotline.com. We also provide Level 2 and Level 3 NDIS support coordination, and TAC and WorkSafe case management. We also have experience with departments of health, DVA, and private health funds to get funding there as well. You do not have to fight this alone.

Long-Term Care at Home with Intensive Care at Home

I founded Intensive Care at Home in 2012 in Australia. To my knowledge, we are the only third-party accredited Intensive Care at Home nursing service in Australia in 2026. Our quality management system is based on ISO 9001:2015 as well as the NDIS standards, and we are NDIS registered. You can check out our quality and safety certificates on intensivecareathome.com/accreditation-quality.

We operate all around Australia in all major capital cities, in all regional and remote areas, in all states and territories. We employ hundreds of years of critical care registered nursing experience combined, which enables us to look after the highest acuity clients in the community safely with our 24/7 critical care registered nursing workforce.

Here is how it works in practice. It starts with a conversation. We look at the clinical needs, the hours of nursing needed, the equipment, and the discharge plan with the hospital team. We work with your treating team — the treating doctors who remain responsible for the medical orders. Our nurses are 24/7 critical care registered nurses who follow the standards in our quality manual. The care is documented at least once per shift, but we also document vital signs, ventilation signs, and so forth hourly.

On the funding side: NDIS support coordination comes in two levels that matter here. Level two is coordination of support, which helps a participant put their plan into action. Level three is specialist support coordination for participants with complex needs and barriers. In both, our role is to help the participant understand their plan, gather the right evidence, and connect with the supports they choose. It is the participant’s choice who provides their nursing and we are transparent about that.

Funding depends on your circumstances. NDIS access generally requires you to be under 65 with a permanent and significant disability. TAC covers transport accident injuries. WorkSafe covers work-related injuries. And there are other pathways including DVA, iCare, and departments of health. Funding is never guaranteed, so get advice early. In our experience, home ICU-level nursing costs roughly half of an ICU bed — so there is a very good chance we can help you to secure that funding.

Questions and Answers

Can a sepsis survivor on a ventilator really go home?
Yes, absolutely — depending on medical stability, whether weaning has been properly explored, funding, equipment, and the trained 24/7 nursing team. The treating doctors decide when the person is clinically ready to go home when there is 24/7 critical care nursing in place.

How long does weaning take after sepsis?
It varies widely — days for some, weeks or months for others, and some remain ventilator-dependent for the rest of their lives. It depends on lung recovery, muscle strength, secretions, swallowing, and overall health.

Is the tracheostomy permanent?
Not necessarily. Many are temporary and removed once the person can breathe and protect their airway independently. Others remain long-term.

Can someone with a tracheostomy and ventilator eat and talk?
Some can — with assessments. A speech pathologist assesses swallowing and whether a speaking valve is safe. Not everyone is suitable. It is a case-by-case basis.

Why 24/7 ICU nurses? Why not general registered nurses, enrolled nurses, or disability support workers?
All of those groups do vital work with daily living support. In our clinical view and in our evidence-based Mechanical Home Ventilation Guidelines, ventilation and/or tracheostomy care requires critical care trained nurses 24/7 because airway and ventilator emergencies must be recognised and managed within seconds or minutes — the same as in a hospital. You would not have a general registered nurse, an enrolled nurse, or a disability support worker in an ICU. You would not have it at home either.

Who pays for 24/7 nursing at home?
Depending on your situation in Australia — NDIS, TAC, WorkSafe, DVA, iCare, private funding, or departments of health. Do not be closed-minded about funding. Do not let hospitals tell you there is no funding. Please reach out to us. We would not exist if we did not know how to help you advocate for funding. Everything is possible — otherwise we would not exist.

What if the hospital says the only option is long-term care?
Ask for the clinical reasons in writing. Request your medical records. Ask whether a home option with 24/7 critical care registered nurses and Intensive Care at Home has been assessed. Get independent advice and reach out to us as well.

Can a tracheostomy tube be changed at home?
Tube changes are a clinical procedure. Our guidelines describe routine changes at intervals such as every 30 to 90 days for long-term tubes. They must be carried out by appropriately trained clinicians in line with the treating doctor’s orders. Families should not be expected to manage this at all.

Do you operate in New York City?
In the United States, we can absolutely operate there. Please contact me through intensivecareathome.com — either send me an email to [email protected] or call me on one of the numbers on the top of the website, including the US number.

What about the emotional side for the patient and the family?
It is absolutely real and very common. PICS can affect mood, sleep, and memory — and families can feel exhausted or traumatised. Speak to the treating team about psychology or counselling support. If you are struggling, please talk to your GP or a mental health professional.

What is the very first step I should take this week?
Request the medical records. Write down your five questions for the hospital. Get advice on funding early. And contact us early as well. If you want expert help — especially when it comes to going home — contact us at intensivecareathome.com through one of the numbers on the top of our website, send me an email to [email protected], or book a call with me by clicking the Schedule Appointment button.

Bringing It All Together

Surviving sepsis is the first victory. Many people do wean off the ventilator and that should always be explored fully. For those who remain ventilator-dependent, home can be a genuine alternative to a long-term stay in intensive care with Intensive Care at Home — but only if the illness is stable, the equipment and funding are in place, and 24/7 critical care registered nurses are at the bedside — for invasive ventilation with tracheostomy, non-invasive ventilation on BiPAP and CPAP, and tracheostomy care without ventilation.

Do not accept a plan that does not answer this question: who is in the room at 3:00 a.m. and are they trained to manage an unstable airway? And it does not matter whether it is 3:00 a.m. or 3:00 p.m. The unstable airway needs to be managed — and that can only ever be a critical care trained registered nurse.

If this was useful, please like the video, subscribe, turn on notifications, share the video with anyone who needs it, and get our free updates at intensivecareathome.com. Call or email us through the website. Call me on one of the numbers on the top of our website or email to [email protected]. Thank you for joining me and I will see you next time. Take care for now.

With all of that said, 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 long-term stay in intensive care for:

• Ventilation
• Tracheostomy
• Home BiPAP (Bilevel Positive Airway Pressure) and CPAP (Continuous Positive Airway Pressure)
• Tracheostomy care without ventilation
• home TPN (Total Parenteral Nutrition)
• Home IV potassium
• Home IV magnesium
• Home IV antibiotics
• Home IV fluids

We’re providing:

• Cough assist management at home
• Ventilation weaning management at home
• central line, PICC (Peripherally Inserted Central Catheter) line, Hickman’s line as well as port management at home
• nasogastric tube, nasojejunostomy tube, PEG (Percutaneous Endoscopic Gastrostomy), PEJ (Percutaneous Endoscopic Jejunostomy) tube management at home
• IDC (Indwelling Catheter) and SPC (Suprapubic Catheter) management at home
• Palliative care services 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 Health District’s In Touch program, saving approximately $2,000 per patient that we keep at home instead of them going into an emergency department.

That also means we’re in a position to cut the cost of an ICU bed by around 50%. An intensive care bed costs between $5,000 to $10,000 per bed day depending on location. Intensive Care at Home costs approximately 50% of that, 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.

Our Coverage and Accreditation

With Intensive Care at Home, we’re currently operating all around Australia, in all major capital cities, as well as in all regional and rural areas. We are an NDIS approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria as well as the Department of Veterans Affairs all around Australia.

We’re also ISO 9001:2015 accredited. 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 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 high level of accreditation since 2012. No other provider in Australia has achieved the Intensive Care at Home 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. And that enables us to look after the highest acuity adults and children in the community in Australia safely.

If You Need Help

If you’re at home already and you’re watching this or you’re stuck in an ICU and you realize that you don’t have the right level of support, I can give you many examples where we helped clients with funding, how we advocate for funding. We had to advocate successfully for funding from our first case study to many other case studies where we had to advocate successfully for funding with the right evidence of course because it is crystal clear that disability support workers for example or registered nurses without ICU experience cannot look after ventilated clients at home whether adults or children with or without a tracheostomy and it’s simply dangerous and negligent.

There are plenty of examples where clients with support worker models or even RN (registered nurse) models without ICU experience have died at home and I have evidence to back up everything that I’m saying here because it’s a bit like flying the airplane with a cabin crew instead of the pilot and it could simply be deadly.  This can be avoided by having simply 24-hour critical care nurses at home because our clients are at high risk of medical emergencies or worse without critical care nurses 24 hours. This is actually also evidence-based in the community and is documented in our evidence-based Mechanical Home Ventilation Guidelines on our website at intensivecareathome.com.

Think about it: in an intensive care unit in a hospital, you wouldn’t have support workers or general registered nurses looking after a critical care patient on a ventilator with a tracheostomy. So why would anyone in their right mind do that in a home care environment where there are fewer resources?

Clients that have found us have been at home long-term predictably and permanently with critical care nurses. Their alternative would have been to either die or stay in ICU long-term, and our clients don’t go back to ICU. They stay at home permanently and predictably and the insurance bodies save half of the cost of an ICU. But it’s a win-win situation all around.

We can do the same for you if you’re stuck in ICU or if you’re not safe at home, which includes the advocacy for funding and the network that goes along with it. We have always successfully advocated for our clients or we have the network to successfully advocate for you and for your family member, otherwise we wouldn’t be in business. The same again is applicable for those stuck in an ICU which is similar to many of our, if not most of our cases.

Our Support Coordination Services

This is also why we are providing Level 2 and Level 3 NDIS support coordination. We have a team of experienced NDIS support coordinators, and they have a wealth of knowledge. 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 or a social worker from another organization or a hospital 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 how to advocate for it, what evidence to provide, I encourage you to reach out to us as well. We have the network to make that happen. 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.

Join Our Team

If you are a critical care nurse and you’re looking for a career change and you want to join a very progressive, dynamic, successful, 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’re looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, Albury-Wodonga, Bendigo, Geelong, Warragul, and also in Wyelangta in Victoria.

If you have worked in critical care nursing for a minimum of two years, adult ICU, pediatric ICU, ED and you have already completed a postgraduate critical care nursing qualification, we will be absolutely delighted hearing from you.

I have a disclaimer, though: Because we are offering tailor-made solutions for our clients which includes regular staff, our clients do also want the same staff coming over and over again because they are so vulnerable and so special. That’s why we need regular, reliable staff. If you’re looking for agency work where you can come and go, this will not be the right fit for you. We’re 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 relationships with us and with our clients. Reliability is also a must.

For Medical Professionals and Healthcare Executives

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 to 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 settings, and you get the same level of care and simply more patient and family satisfaction because you also want to partner with your consumers.

If you are a hospital executive watching this, we can help you free up your ICU and ED beds.

International Support

If you’re in the U.S. or in the UK 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, click the like button, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and Intensive Care Hotline. Click the like button, click the notification bell, and share this video with anyone who has a family member in intensive care long-term or needs to see this.

Thank you so much for watching.

This is Patrik Hutzel from intensivecareathome.com and I’ll talk to you in a few days.

Take care for now.