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 www.intensivecarehotline.com , where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can have real power, real control and so that you can influence decision making!
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 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 however gives you answers to how long it should take your loved one to be weaned off the ventilator and the Tracheostomy.
A Tracheostomy is generally a straight forward procedure in Intensive Care and after the 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, keep in mind, your critically ill loved one has been placed in an induced coma(What is an induced coma and why is my critically ill loved one in an induced coma? Find more information here http://intensivecarehotline.com/induced-coma-critically-ill-loved-one-induced-coma/ )
,so that he or she was able to tolerate the breathing tube. A Tracheostomy tube is 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.
Therefore, sedation can be weaned, reduced or even completely switched off and the number of drugs given are minimized which is a good thing. With the sedation minimized, 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 or Trachea hood) above the Tracheostomy. 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
• Lack of Quality of Life in Intensive Care
• Lack of Privacy& Dignity in Intensive Care
• Feeling helpless and not in control of the situation
• disturbed day and night rhythm
• lack of sleep or sleep deprivation
• lack of natural daylight
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.
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.
There are a number of Patients in 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.
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, irrespective of what the Intensive Care team is telling you. In some countries now, mainly in Australia, the USA and Germany, specialized 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.au
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 are living in an area where such services are not available we have more FREE resources prepared for you that will help you to have control, power so that you can influence decision making. Those reports will give you massive “behind the scene 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 is telling you! If you are interested in the following FREE reports or if you have any other questions, just send me an email to [email protected] or to [email protected]
The FREE reports when you send me an email are
- “6 answers to the 6 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”
- “Follow this proven 5 step process on how to be in control and influential if your loved one is a long-term Patient in Intensive Care or is facing treatment limitations in Intensive Care”
- “The 5 things you need to know if the medical team in Intensive Care wants to limit treatment, wants to withdraw treatment or wants to issue an NFR(not for resuscitation) order for your critically ill loved one in Intensive Care”
If you want to quickly learn how to have more power, control and how you can influence decision making in Intensive Care, whilst your loved one is critically ill or is dying in Intensive Care, also download your FREE “INSTANT IMPACT” REPORT NOW. In the 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 this free report you’ll also discover
• how to ask the doctors and the nurses the right questions
• how to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
• 5 “killer” tips& strategies helping you to get on the right path to control, power and influence in your situation
• you’ll get crucial ‘behind the scenes’ insight so that you 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)
With your FREE “INSTANT IMPACT” report you’ll also get 4 other FREE reports and the reports you will be receiving are
- The 6 questions you need to ask the most senior doctor in Intensive Care
- 10 things you didn’t know doctors and nurses are talking about while you are not at the bedside with your loved one
- The 7 answers to the 7 most FAQ if your loved one is critically ill in Intensive Care
- 9 myths of being a critically ill Patient in Intensive Care
Thank you for tuning into this week’s blog and I’ll see you again in another update next week! Make sure you also check out our “your questions answered” section or send me an email to [email protected]
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