This blog post was first published at our sister site INTENSIVECAREHOTLINE.COM a support and resource website for Families of critically ill Patients.
Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM , where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, get PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “your questions answered” and in this week’s episode I want to shed light on the question
TRACHEOSTOMY AND WEANING OFF THE VENTILATOR IN INTENSIVE CARE, HOW LONG CAN IT TAKE?
If your critically ill loved one has been in Intensive Care on a breathing tube/endotracheal tube, on a ventilator and 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 those related articles and videos here
Today’s episode of ‘YOUR QUESTIONS ANSWERED’ however gives you answers to how long it should take your loved one to be weaned off the ventilator and the tracheostomy in Intensive Care or in LTAC(=Long-term acute care facility) .
Before I go into the details to answer today’s question, let me share word of warning with you when it comes to tracheostomies in Intensive Care that is specific for our readers and clients in the US.
A tracheostomy is often used as a money saver in Intensive Care in the US and also as a vehicle to manage and empty “in-demand” and very expensive Intensive Care beds.
I’m glad you’ve asked.
Because an “in-demand” Intensive Care bed costs around $5,000 per bed day, ICU’s are wanting to empty their beds and they do so by doing a tracheostomy and sending Patients to LTAC(=Long-term acute care facilities).
There is also often pressure from health insurances to get into LTAC’s due to lower cost, without actually taking clinical need for Intensive Care into consideration due to the ventilation and tracheostomy!
If you are finding yourself in a situation where the ICU is suggesting a tracheostomy, you need to make sure that your loved one can stay in ICU for as long as it takes to wean your loved one off the ventilator and tracheostomy.
Why? Because mechanical ventilation and tracheostomy requires the specialist skills of ICU doctors, ICU nurses, ICU Physios, Respiratory therapists etc…
LTAC’s do have none of those skills available. There are no ICU nurses, no ICU doctors etc…
The only genuine alternative to a long-term stay in Intensive Care and/or LTAC with tracheostomy and ventilation is INTENSIVE CARE AT HOME where ICU nurses provide services up to 24/7 and I will explain more about that in detail in a moment.
I can’t tell you how many families come to us when they have a loved one in LTAC and they are literally begging us to help them get their loved one out of LTAC and back into ICU. We can do that as part of our professional advocacy and consulting service, however it is much smarter to ask questions beforehand, making sure your loved one isn’t going to end up with a tracheostomy unnecessarily if your loved one could have been weaned off the ventilator and the breathing tube/endotracheal tube in the first place.
We can also help you advocate successfully to keep your loved one in Intensive Care after tracheostomy.
Here is a link to a case study how we helped one of our clients to stay in Intensive Care instead of going to LTAC or long-term acute care after having a tracheostomy. The outcome was successful consulting and advocacy where the client’s Dad was able to be weaned off ventilation and tracheostomy in ICU!
- WHAT THEY DON’T TELL YOU IN INTENSIVE CARE WHEN IT COMES TO WEANING FROM TRACHEOSTOMY AND VENTILATION!
On to answering your question.
A Tracheostomy is generally speaking a straight forward procedure in Intensive Care and after a tracheostomy has been inserted, generally speaking the weaning process for your critically ill loved one to come off the ventilator can be started immediately.
That being said, before a decision for a tracheostomy has been made, there is a very good chance that your critically ill loved one has been or was placed in an induced coma.
An induced coma generally speaking is necessary for intubation(=insertion of a breathing tube/endotracheal tube), mechanical ventilation so that your loved one is able tolerate the breathing tube/endotracheal tube.
A tracheostomy tube is so much easier to tolerate for your critically ill loved one and he or she does not need any sedation(drugs that make your loved one sleepy) for it. Again, for mechanical ventilation with a breathing tube/endotracheal tube an induced coma and sedation was necessary.
Therefore, sedation can be weaned, reduced or even completely discontinued after tracheostomy insertion.
Therefore, the number of drugs given for sedation and pain relief can often be minimized or they can be completely discontinued, which is a good thing. With the sedation minimized or ceased, 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.
The first steps to being weaned off the ventilator and the tracheostomy can often be taken on the same day the tracheostomy has been done! Sometimes there can be delays, however the goal should always be to wean your loved one off the ventilator and the tracheostomy as quickly as possible in Intensive Care instead of going to LTAC!
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 to 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 hood, trachea shield or trachea collar) instead of the ventilator.
That usually gives you, your critically ill loved one and the ICU 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 week or two 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 he or she can be without the ventilator for >24 hours. After your loved one has been without the ventilator for a few days, he or she 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 delay and prolong the weaning process.
The most common issues that might delay and prolong the weaning process are
• Respiratory conditions such as Pneumonia, COPD, Asthma, Pleural effusion
• Lung transplant
• Excess sputum production that requires regular and frequent suctioning via the tracheostomy
• Neurological conditions such as stroke, brain or head injuries
• Confusion and aggression
• Depression in Intensive Care or LTAC
• Lack of Quality of Life in Intensive Care/LTAC
• 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/LTAC can therefore then take many weeks and many months before a discharge out of Intensive Care or LTAC is possible.
Depression and lack of Quality of Life
After the clinical issues are taken care of in Intensive Care/LTAC, 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/LTAC. Increased length of stay in Intensive Care/LTAC, 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 or LTAC
There are a number of Patients in Intensive Care or in LTAC that are long-term ventilator dependent with Tracheostomy and they are therefore “trapped” in Intensive Care or LTAC 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/LTAC 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 Home Care Nursing is a solution to the dilemma
After a few weeks or after a few months in Intensive Care/LTAC 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/LTAC 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 or LTAC’s 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, irrespective of what the Intensive Care team is telling you. In some countries now, mainly in Australia, the USA and Germany, specialized, holistic and comprehensive Intensive Home Care services are available to take your critically ill loved one home so that he or she, but also their Families can have Quality of Life and or Quality of end of Life. For more information visit www.intensivecareathome.com
Patient and Family focused holistic services that are not institutionalised
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, institutionalised, 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/LTAC, where weaning off the ventilator is possible as well, in a much more Patient and Family friendly environment.
If you are living in an area where such services are not available we have more resources prepared for you that will help you to have control, power so that you can influence decision making. Those reports will give you this crucial “behind the scenes insight” that is crucial for you having power, control and influence.
You shouldn’t and you don’t need to take for face value what the Intensive Care team or the LTAC is telling you!
If you are interested in the following Ebooks and Videos or if you have any other questions click on the links below or just send me an email to [email protected]
The Ebooks and Videos that are highly relevant if your loved one is critically ill on a ventilator are (click on the links)
- “7 answers to the 7 most frequently asked questions, if your loved one requires ongoing mechanical ventilation with Tracheostomy in INTENSIVE CARE”
- “Follow this proven system to avoid the 3 most dangerous mistakes you are making but you are unaware of, if your loved one is a long-term ventilated Patient with Tracheostomy in Intensive Care”
How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?
You get to that all important feeling of making informed decisions, get PEACE OF MIND, CONTROL, POWER AND INFLUENCE when you download your FREE “INSTANT IMPACT” report NOW by entering your email below!
In Your FREE “INSTANT IMPACT” report you’ll learn quickly how to make informed decisions, get PEACE OF MIND, real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Your FREE “INSTANT IMPACT” Report gives you in-depth insight that you must know whilst your loved one is critically ill or is even dying in Intensive Care!
Sign up and download your FREE “INSTANT IMPACT” REPORT now by entering your email below! In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care! In your FREE report you’ll also discover
- How to ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
- How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
- 5 mind blowing tips& strategies helping you to get on the right path to making informed decisions, get PEACE OF MIND, control, power and influence in your situation
- You’ll get real world examples that you can easily adapt to your and your critically ill loved one’s situation
- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
- You’ll get crucial ‘behind the scenes’ insight so that you know and understand what is really happening in Intensive Care
- How you need to manage doctors and nurses in Intensive Care (it’s not what you think)
Thank you for tuning into this week’s YOUR QUESTIONS ANSWERED episode and I’ll see you again in another update next week!
Or you can call us! Find phone numbers on our contact tab.
Also check out our Ebook section where you get more Ebooks, Videos and Audio recordings and where you can also get 1:1 counselling/consulting with me via Skype, over the phone or via email by clicking on the products tab!
This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
For more information and to get your FREE “INSTANT IMPACT” Report visit INTENSIVECAREHOTLINE.COM