Hi it’s Patrik Hutzel from INTENSIVE CARE AT HOME where we provide tailor made solutions for long-term ventilated Adults& Children with Tracheostomies by improving their Quality of life and where we also provide tailor made solutions to hospitals and Intensive Care Units to save money and resources, whilst providing Quality Care!
In the last blog I answered a question from one of our readers of our blog and the question last week was
You can check out last week’s episode by clicking on the link here.
In this week’s blog I want to answer another question that we get quite frequently from our readers and also from clients who want to or take up our service INTENSIVE CARE AT HOME and the question this week is
TRACHEOSTOMY AND WEANING OFF THE VENTILATOR IN ICU, HOW LONG CAN IT TAKE?
It’s a great question to ask, especially for anyone who has a loved one in Intensive Care on a ventilator with tracheostomy whether it be an adult, child or even a toddler.
Especially if you and your family have been putting your life on hold because your loved one stays in ICU/PICU or NICU for many weeks or months on end, you and your family need to ask this question and you need to look at genuine alternatives to a long-term stay in Intensive Care and we can offer you this genuine alternative to a long-term stay in Intensive Care with INTENSIVE CARE AT HOME!
If your critically ill loved one has been in an induced coma and now has a Tracheostomy, there are several reasons, why your critically ill loved one required a Tracheostomy, most of the reasons for a Tracheostomy you’ll find are outlined in this blog post here “How long should a Patient be on a ventilator before having a Tracheostomy?”
This blog post today, however gives you answers to how long it should take your loved one to be weaned off the ventilator and the Tracheostomy and it looks at genuine alternatives like INTENSIVE CARE AT HOME.
A Tracheostomy is generally a straight forward procedure in Intensive Care and after the Tracheostomy has been inserted, generally speaking and in many cases, the weaning process for your critically ill loved one to come off the ventilator can be started immediately.
That being said, keep in mind, your critically ill loved one has been placed in an induced coma so that they were able to tolerate the breathing tube. A Tracheostomy tube is much easier to tolerate for your critically ill loved so that they don’t need any sedation(drugs that make your loved one sleepy) for it.
Therefore once a tracheostomy has been done, sedation can be weaned, reduced or even completely switched off and the number of drugs given are minimised which is a good thing. With the sedation minimised, your loved one should come out of the induced coma and should then be ready to take the first steps to be weaned off the ventilator.
Those first steps are usually to reduce support from the ventilator and let your loved one do more of the work required to breathe, whilst still getting support from the ventilator and then the next step is take your critically ill loved one off the ventilator completely for a few hours and just support him or her with an oxygen mask(Trachea mask, Trachea shield or Trachea hood) just above the Tracheostomy.
This usually gives you, your critically ill loved one and the ICU team or a home care team a good indication of how long the process might take to wean your loved one off the ventilator. The frequency that your loved one stays off the ventilator should increase day by day, with the goal to be off the ventilator within a few days or a few weeks at the most.
This is if all goes well and as planned. Sometimes your loved one may stay off the ventilator during the day and go back on the ventilator again during the night, until they can be without the ventilator for 24 hours. After your loved one has been without the ventilator for a few days, they should be able to have the Tracheostomy removed as well, if your loved one has a good strong cough and after a swallowing assessment has been done.
Depending on the underlying admission scenario and other medical issues that your critically ill loved one is dealing with, the process of weaning your critically ill loved one off the ventilator might not be a straight forward process and numerous setbacks might occur and therefore delay and prolong the weaning process.
The most common issues that might delay and prolong the weaning process are
- Excess sputum production that requires regular and frequent suctioning via the Tracheostomy
- Confusion and aggression
- Depression in Intensive Care or LTAC
- Lack of Quality of Life in Intensive Care
- Lack of Privacy& Dignity in Intensive Care or LTAC
- Feeling helpless and not in control of the situation
- disturbed day and night rhythm
- lack of sleep or sleep deprivation
- lack of natural daylight
and sometimes there can also be a psychological dependency on ventilation support, especially after many setbacks and failed trials to come off the ventilator!
These are the most common scenarios where a weaning off the ventilator with a Tracheostomy can be delayed and therefore difficult and the weaning process in Intensive Care can therefore then take many weeks and many months before a discharge out of Intensive Care is possible.
Depression and lack of Quality of Life
After the clinical issues are taken care of in Intensive Care, you may find that your loved one gets depressed in Intensive Care, because of the lack of Quality of life, the feeling of helplessness, the lack of privacy and dignity, the sleep deprivation and because of the disturbed day and night rhythm and this can turn into a vicious cycle with the ventilator dependency triggering the depression and the depression triggering the ventilator dependency. This is especially true the longer your critically ill loved one stays in Intensive Care. Increased length of stay in Intensive Care, depression and lack of Quality of life usually go hand in hand.
This means that your critically ill loved one might get psychologically dependent on the ventilator because of the reasons outlined above and again, delay the process of your loved one being able to breathe without a ventilator.
Trapped in Intensive Care
There are a rising number of Patients in Intensive Care(including Paediatric and neonatal Intensive Care) that are long-term ventilator dependent with Tracheostomy and they are therefore “trapped” in Intensive Care with no Quality of Life and often with no perceived alternative but to stay in Intensive Care for long periods of time, without ever leaving Intensive Care. Those Patients and their Families in Intensive Care feel like they have no control over the situation and they therefore feel like they are at the mercy of the Intensive Care doctors and nurses.
INTENSIVE CARE AT HOME Nursing is a solution to the dilemma
After a few weeks or after a few months in Intensive Care because of the ventilator dependency, there is a relatively high chance that your critically ill loved is getting weaker and weaker and is losing the will to live. The inhibiting and limiting Intensive Care environment where Quality of Life and/or Quality of-end-of-life can not be achieved, are more often than not a downward spiral for your critically ill loved one and many Intensive Care Units may actually tell you that because of the inability for your critically ill loved one to move forward that they may have to “withdraw treatment” or limit treatment and let your loved one die.
This would be very sad and it certainly doesn’t have to be that way because there are ways forward and that includes INTENSIVE CARE AT HOME.
INTENSIVE CARE AT HOME improves Patients and their families’ quality of life and in some instances quality of end of life.
We are all about creating win-win situations and that includes helping Intensive Care Units free up their in-demand, expensive and therefore precious Intensive Care beds!
We are able to reduce the cost of a $5,000- $6,000 per bed day Intensive Care bed significantly to about 50% of the cost and Patients and families are in a much more Patient and family friendly home care environment!
Patient and Family focused services that are not institutionalized
Usually, in an Intensive Home Care environment, Quality of Life can be restored and Patients and their families have real control over their lives and they are far less dependent on a regimented, institutionalized, sterile and clinical environment. Some ventilator dependent Adults& Children are able to go back to work or go back to school, University or kindergarten with the support structure of an Intensive Home care service. Intensive Care Home services provide 24/7 care and provide similar services compared to Intensive Care, where weaning off the ventilator is possible as well, in a much more Patient and Family friendly environment.
If you want to find out how we can help you to get your loved one out of Intensive Care including palliative care or Long-term acute care(also nursing home) or if you find that you have insufficient support for your loved one at home on a ventilator or if you have any questions please send me an email to [email protected] or call on one of the numbers below.
Australia/New Zealand +61 41 094 2230
USA/Canada +1 415-915-0090
UK/Ireland +44 118 324 3018
Also, check out our careers section here
We are currently hiring ICU/PICU nurses for clients in Melbourne, Sunbury and in South Gippsland/Victoria.
We are an NDIS, TAC(Victoria) and DVA(Department of Veteran affairs) approved community service provider in Australia.
We have also been part of the Royal Melbourne health accelerator program earlier this year!
Thank you for tuning into this week’s blog.
This is Patrik Hutzel from INTENSIVE CARE AT HOME and I see you again next week in another update!