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What do you do when your daughter is in the ICU on a ventilator, has just had a tracheostomy, recently had open heart surgery, has a blood yeast infection, Crohn’s disease, acute kidney injury, and the ICU team is pushing for long-term care? You fight and you get the right information, and that’s exactly what today’s video is all about.

 

Welcome to Intensive Care at Home and to another Intensive Care at Home video.

 

At Intensive Care at Home, we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies, tailor-made solutions at home for long-term ventilated adults and children on bilevel positive airway pressure (BiPAP) and continuous positive airway pressure (CPAP) without tracheostomy, and we provide tailor-made solutions for tracheostomy adults and children without ventilation. We provide home ventilation weaning, home cough assist management, home total parenteral nutrition (TPN), home intravenous (IV) fluids, home IV antibiotics, home IV potassium, home IV magnesium infusions, central line, peripherally inserted central catheter (PICC) line, Hickman’s line, port management at home, nasogastric tube, nasojejunostomy tube, percutaneous endoscopic gastrostomy (PEG) tube, PEJ (Percutaneous Endoscopic Jejunostomy) tube, indwelling catheter (IDC), suprapubic catheter (SPC) management at home, as well as palliative care management at home.

We also provide level 2 and level 3 National Disability Insurance Scheme (NDIS) support coordination, as well as Transport Accident Commission (TAC) and WorkSafe case management.

 

Every week I receive messages from families who are navigating one of the most frightening experiences of their lives — watching a loved one in the ICU, connected to machines, and not knowing what to do next. This week I want to share a message from Mike, who is doing an absolutely extraordinary job keeping his daughter alive and advocating fiercely for her to come home. Mike, I want to say this clearly: what you are doing is remarkable. You are not just a father — you are your daughter’s best clinical advocate, and that advocacy may well save her life. Keep going.

 

Here is Mike’s question:

 

“Hi Patrik, 

I have a few questions. My daughter received a tracheostomy today. She has been on the ventilator for 3.5 weeks, has other issues like Acute Kidney Injury, Crohn’s, HS, blood clots and had open heart surgery 30 days ago to remove large clotting from her heart. Also, recently diagnosed with a blood yeast infection that they’ve started to treat with antibiotics. I would like your advice for discussing a weaning plan with the ICU team and what a good plan should include. Could this include CPAP and type of medications to guard against throat swelling and mucus in the chest, use of opiates, etc? Another question relates to Long Term Acute Care. If the ICU Team insist on discharging my daughter to long term care, what is the best way to handle this, please advise. I don’t want her to go to long term care but want her to go home with INTENSIVE CARE AT HOME. About her Yeast infections in the blood, what is the best approach to treat? What antibiotics? And lastly, what advice can you give me about the Feeding tubes in consideration of my daughter’s history of gastrointestinal infection and bleeding due to Crohn’s disease? I have read quite a bit of your ebooks and consumed your video content as well. I’m convinced INTENSIVE CARE AT HOME is the way to go if she needs ventilation +/- tracheostomy. Thank you, Patrik. From Mike.”

 

Mike, thank you for trusting me with this. These are exactly the right questions to be asking — and the fact that you are asking them at this stage gives your daughter a real fighting chance. Let me go through each question carefully.

 

1. What Should a Good Ventilator Weaning Plan Include After Tracheostomy?

First, let’s be clear about why a tracheostomy has been performed. After 3.5 weeks on a ventilator, your daughter’s team has made a clinical decision that she is not going to be extubated (have the breathing tube removed from her mouth) quickly. A tracheostomy — a surgical opening in the neck through which a tracheostomy tube is placed — makes long-term ventilation safer, more comfortable, and creates a pathway to weaning.

 

When you sit down with the ICU team to discuss a weaning plan, here are the key areas you want to ask about:

 

Spontaneous Breathing Trials (SBTs)

Ask the team when they plan to start spontaneous breathing trials. These are periods where your daughter breathes on her own with minimal or no ventilator support, to assess her ability to sustain breathing independently. The frequency and duration of SBTs should be documented in the plan.

 

CPAP and Pressure Support Weaning

CPAP (Continuous Positive Airway Pressure) is often used as part of weaning — the ventilator provides a constant pressure to keep the airways open, but the patient does the breathing work. As your daughter improves, the team should gradually reduce the pressure support level (the extra boost the ventilator gives to each breath). Ask: what is the current pressure support level, and what is the target before considering extubation or tracheostomy capping?

 

Tracheostomy Capping Trials

A critical milestone in weaning is tracheostomy capping — placing a cap over the tracheostomy tube so all breathing goes through the mouth and nose. This tests whether your daughter can protect and maintain her own airway. This is typically done in stages, and only when she is strong enough. Ask the team when they plan to start capping trials.

 

Medications: Managing Airway Secretions and Swelling

This is an excellent question, Mike. Medication management during weaning includes:

• Mucolytics (e.g. N-acetylcysteine, hypertonic saline): Help thin and clear mucus from the airways and chest.
• Nebulized saline and bronchodilators: Can help open airways and mobilize secretions.
• Corticosteroids (e.g. dexamethasone): Sometimes used to reduce subglottic (throat) swelling, particularly important if extubation or tracheostomy downsizing is being planned.
• Opioid management: This is a delicate balance. Opioids (pain medications) can suppress breathing drive, which is a problem during weaning. Ask the team what their plan is to gradually reduce opioid doses in parallel with weaning — this is called co-weaning. Too much opioid and she cannot breathe independently. Too little and she is in pain and cannot cooperate with weaning.
• Sedation minimization: Daily sedation holidays — periods where sedation is deliberately reduced — are now standard of care in ICU weaning. Ask if this is being done.

 

Physiotherapy and Respiratory Therapy

Active physiotherapy — including chest physiotherapy, airway suction, positioning, and early mobilization — is a cornerstone of weaning. Ask what the daily physiotherapy plan looks like. This is not optional; it is evidence-based care.

For our full evidence-based guidelines on mechanical home ventilation and weaning, I encourage you to read our evidence-based Intensive Care at Home Mechanical Home Ventilation Guidelines.

 

2. If the ICU Team Pushes for Long-Term Acute Care — What Do You Do?

Mike, this is where your advocacy becomes absolutely critical — and I want you to know that you have rights here. Many ICU teams, under enormous bed pressure, will push families toward long-term acute care (LTAC) facilities or sub-acute nursing homes. They may frame it as the only option. It is not.

Here is what I recommend:

• Request a formal family meeting: Ask for a meeting with the ICU consultant, the nurse unit manager, the social worker, and the discharge planner. Have a list of your questions written down. Do not accept verbal conversations in corridors.
• Ask for the discharge plan in writing: Any proposed discharge destination should be put in writing. Ask what the criteria are for discharge and whether those criteria have been met.
• Get your daughter’s medical records: You have the legal right to request copies of all medical records, nursing notes, and investigation results. This is your right as next of kin (or your daughter’s legal representative). These records will be critical if you need to challenge decisions.
• Challenge the assumption that LTAC is necessary: Ask the team specifically: ‘What would need to be in place for my daughter to go home rather than to a long-term facility?’ Make them answer this question. Often, the answer is a capable nursing team and appropriate equipment — which is exactly what Intensive Care at Home provides.
• State clearly that home is your goal: Document in the medical record — ask the nursing staff to note it — that it is your family’s stated goal for your daughter to return home with Intensive Care at Home nursing. This creates a formal record of your preference.

 

Long-term acute care facilities are not the same as home. Outcomes for ventilator-dependent patients in institutional care are significantly worse than for those who transition to a well-managed home environment. The evidence for this is strong, and it is the foundation of what we do at Intensive Care at Home.

 

We are the only intensive care at home nursing service in Australia that is third-party accredited for intensive care nursing at home —NDIS registered and ISO 9001:2015 certified, audited by BSI Group, with zero non-conformances at our most recent audit. You can verify this at: intensivecareathome.com/accreditationquality. Our team brings hundreds of years of critical care nursing experience into the community. No other nursing service brings a higher skill level into the community in 2026 in Australia. This skill level enables us to care for the highest acuity clients in the community in Australia.

We operate all around Australia in all states and territories.

 

And if you’re in the USA, Canada, UK, India or any other country please contact us, we will help you in those countries as well.

 

3. Blood Yeast Infection (Candidaemia): What Is the Best Approach?

Mike, I need to flag something important here. You mentioned that your daughter has a blood yeast infection and that the team has started treating it with ‘antibiotics.’ I want to clarify this because it matters clinically.

 

Yeast infections in the blood are not treated with antibiotics — they are treated with antifungals. Antibiotics treat bacterial infections. If the team is treating a yeast (fungal) bloodstream infection, the correct medications are antifungals, most commonly:

• Echinocandins (e.g. anidulafungin, caspofungin, micafungin): These are the first-line recommended treatment for candidaemia (yeast in the blood) in critically ill patients, according to international guidelines. They are administered intravenously.
• Fluconazole: May be used in less severe cases or in step-down therapy once the patient is clinically stable and the yeast strain is confirmed to be susceptible.
• Amphotericin B: Used in more resistant or severe cases, but has significant side effects including kidney toxicity — which is already a concern given your daughter’s Acute Kidney Injury.

The most critical steps in treating candidaemia are:

• Starting antifungal therapy promptly — delay increases mortality.
• Removing or replacing any central venous catheters (CVCs) where possible, as these are a major source of fungal bloodstream infections.
• Repeating blood cultures every 48–72 hours until they clear, to confirm the infection is responding to treatment.
• Ophthalmology review — all patients with candidaemia should have their eyes examined for fungal endophthalmitis (fungal infection of the eye).
• Echocardiography to exclude fungal endocarditis (infection of the heart valves) — especially important given your daughter’s recent open heart surgery.

 

I strongly recommend you ask the ICU team to clarify exactly which antifungal agent is being used, what the blood culture results show (species and sensitivity), and whether all the steps above have been taken. These are not unreasonable questions — they are standard of care.

 

Important disclaimer: I am providing this information for educational purposes only. This is not a substitute for the direct clinical assessment and advice of your daughter’s treating team. Always discuss specific medication decisions with her doctors.

 

4. Feeding Tubes and Crohn’s Disease — What Do You Need to Know?

This is one of the most clinically complex aspects of your daughter’s case, Mike, and it requires careful thought. Let me explain why.

 

Why Nutrition Matters Critically in ICU

After 3.5 weeks in the ICU following open heart surgery, your daughter will have significant muscle wasting and nutritional depletion. Nutrition is not optional — it is medicine. Without adequate nutrition, weaning from the ventilator becomes extremely difficult, wounds do not heal, immune function is compromised, and recovery is prolonged.

 

The Challenge: Crohn’s Disease and GI Complications

Crohn’s disease creates a serious challenge for enteral (gut-based) nutrition because:

• The gut may be inflamed, narrowed, or dysfunctional due to Crohn’s.
• Crohn’s patients are at higher risk of gastrointestinal bleeding, which is already a documented issue for your daughter.
• Stress from critical illness, surgery, blood thinners (anticoagulants for the blood clots), and medications can all worsen GI inflammation and bleeding risk.

 

Types of Feeding Tubes: What Should Be Considered?

• Nasogastric (NG) tube: A tube through the nose into the stomach. The first option tried in most ICU patients. With active Crohn’s and GI bleeding history, gastric feeds must be started cautiously and at low rates, with close monitoring of gastric residual volumes and signs of intolerance.
• Post-pyloric feeding (nasojejunal or NJ tube): A tube that bypasses the stomach and delivers feed directly into the small intestine. This may be preferable if your daughter has gastroparesis (slow stomach emptying — common in critically ill patients) or if gastric feeding is not tolerated.
• Elemental or semi-elemental formulas: These are pre-digested formulas that are easier for an inflamed gut to absorb. Given your daughter’s Crohn’s, the ICU dietitian and gastroenterology team should specifically consider whether a standard polymeric feed is appropriate or whether an elemental formula is safer.
• Parenteral nutrition (TPN): Nutrition delivered directly into the bloodstream via a central line, bypassing the gut entirely. If enteral feeding is genuinely not tolerated due to active GI bleeding or severe gut dysfunction, TPN may be necessary — but it carries its own risks, including catheter-related infections, liver complications, and blood sugar instability. It should be considered a bridge, not a long-term solution.

 

Key Questions to Ask the Team

• Is there a gastroenterology (GI) specialist involved in my daughter’s care?
• Has an ICU dietitian assessed her and calculated her caloric and protein targets?
• Is her gut being monitored for signs of bleeding or intolerance during feeding?
• What is her current feeding rate, and is she meeting her nutritional targets?
• Has the choice of feed formula been discussed in the context of her Crohn’s disease?

 

At Intensive Care at Home, when we bring ventilator-dependent patients home, managing enteral and parenteral nutrition is a core part of what our Critical Care Registered Nurses do every day. It is not beyond the scope of home care — it is our expertise.

 

How Intensive Care at Home Can Support Your Daughter

Mike, you said you are convinced that Intensive Care at Home is the way to go — and I believe you are right. Let me tell you what that looks like in practice. Intensive Care at Home is the only intensive care at home nursing service in Australia that is third-party accredited specifically for intensive care nursing in the home setting. We are NDIS registered and we hold ISO 9001:2015 certification, audited by BSI Group, with zero non-conformances at our December 2025 audit.

Our team of 150+ Critical Care Registered Nurses provides:

• 24/7 ventilator management and monitoring at home
• Tracheostomy care — suction, tube changes, capping trials, and airway management
• Enteral and parenteral nutrition management
• Medication administration including IV antifungals where required
• Dialysis support for Acute Kidney Injury management
• Pressure injury prevention and wound care
• Coordination with your daughter’s specialist teams

 

We operate all around Australia in all states and territories. If you want to understand exactly how we can support your daughter’s transition home, the first step is to contact us directly.

 

Work With us Directly 

visit intensivecareathome.com.

You can call me directly on 041 094 2230 or 1300 921 536 or email to [email protected] or book a call with me here. (http://intensivecarehotline.com/scheduling-appointment/)

Mike — keep going. You are doing an exceptional job. Your daughter is fortunate to have a father who refuses to accept anything less than the best possible care and outcome for her. The road ahead is hard, but you are asking exactly the right questions, and that matters more than you know.

 

If this post has helped you, please share it with another family going through something similar. And if you have a question you would like me to answer, leave it in the comments below or send it to me directly.

 

Until next time — advocate hard, ask questions, and know that bringing your loved one home is possible. — Patrik Hutzel

 

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. 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.