If you want to know what is evidence-based care for C1 and C2 spinal cord injuries who are on a ventilator and a tracheostomy at home, stay tuned. I’ve got news for you.

My name is Patrik Hutzel from intensivecareathome.com. I have a video today, “What is actually evidence-based care for C1, C2 spinal cord injuries on a ventilator with a tracheostomy at home?”

Now first off, looking after C1 and C2 spinal injury clients at home, whether adults or children, is a very complex endeavor. It requires careful attention to medical nursing, respiratory, and psychological needs.

Here are the evidence-based guidelines to ensure best care and treatment for C1, C2 spinal injury on ventilation tracheostomy.

So, let’s start off with respiratory management because unfortunately nothing happens without respiratory management for patients on ventilation with tracheostomy, with C1 and C2 spinal injury.

So first off, we have to look at evidence-based Mechanical Home Ventilation Guidelines that you can find on our intensivecareathome.com website. Evidence-based Mechanical Home Ventilation Guidelines clearly say that only and exclusively critical care nurses with a minimum of 2 years intensive care and critical care nursing experience, ideally with a postgraduate critical care nursing qualification, are qualified to look after ventilation and tracheostomy clients at home. 

Once again, that is evidence-based that comes out of over 25 years of Intensive Care at Home nursing in Germany. It comes out of over 13 years of Intensive Care at Home nursing in Australia.

So clearly, the evidence is overwhelming because with ventilation support comes that we need to ensure that ventilator settings are appropriately adjusted according to the client’s respiratory needs. This includes maintaining proper tidal volume respiratory rate, oxygen levels. The ventilation modes level needs to be checked hourly for, again, tidal volume levels, oxygen levels, minute volume levels, mean pressures, and so forth, making sure that there’s adequate oxygenation, adequate oxygen perfusion, of course, no barotrauma, patients need to have chest auscultations daily, more than once daily. They need to be on an oxygen saturation probe, of course, pulse oximeter, and so forth, and that requires the skill and care of a critical care nurse, 24 hours a day. That goes without saying really.

Now, like I said, the evidence is that the Mechanical Home Ventilation Guidelines on our website at intensivecareathome.com, but also invasive mechanical home ventilation in spinal cord injuries, emphasizing individualized care plans (Miller et al, 2017). 

Next, tracheostomy care. Regular cleaning and maintenance of the tracheostomy tube are vital to prevent infection. This includes suctioning when required and changing the tracheostomy tube as per protocol. Once again, that is exclusively the skill of critical care nurses and critical care doctors, of course. It goes without saying that this doesn’t even fall into the realm of a registered nurse without ICU or critical care experience, let alone it doesn’t fall into the domain of families or people that are not registered nurses and not trained in intensive care.

Evidence. Studies show that appropriate suctioning techniques and sterile tracheostomy care reduce the risk of respiratory infection and complications in spinal cord injury patients (Bertocchini et al., 2016).

Next, humidification. Use of a humidification system to moisten inspired air or oxygen helps reduce mucous plugging and airway irritation. Once again, on top of that is obviously regular nebulization, regular saline nebulizers. I’d say at least 4 to 6 hourly. We also help with a reduction mucus plugging and inspiring air or oxygen and avoids airway irritation.

Evidence. Proper humidification improves secretion management and respiratory comfort as indicated by systemic reviews on tracheostomy care (Hall et al., 2019).

Number 2, Skin and Pressure Ulcer Prevention.

Positioning. Ensure frequent repositioning to prevent pressure sores, especially since these clients are at much higher risk due to limited mobility. A schedule for turning over 2 hours is often recommended.

Evidence. Pressure ulcers are a common complication for spinal cord injury patients and frequent repositioning is a critical intervention (Mikami et al., 2020). Again, the frequent repositioning, once again, is a skill of a registered nurse 24/7.

Next, pressure-relieving cushions and mattresses. Use specialized cushions and mattresses to reduce the risk of pressure ulcers. These devices help evenly distribute pressures. We mainly have our spinal cord injury patients on air mattresses but also, sometimes on sheep skin.

Evidence. A systematic review confirmed that using pressure-relieving devices reduces the risk of ulcers in spinal cord injury patients. Whilst I don’t have any evidence, what I’m saying next, I do believe I have read somewhere that many spinal cord injury patients, one of the main causes of death is sepsis, which is a result of pressure sores.

Number 3, Nutrition and Hydration.

Feeding protocols. Since clients with C1, C2 injuries may have impaired swallowing or a compromised gag reflex, feeding via enteral nutrition, i.e. via a PEG tube or nasogastric tube, might be required. Ensure that nutrition is properly tailored to the individual’s needs.

Clearly, the evidence is nutrition support is essential for recovery and preventing malnutrition, especially when swallowing is impaired. On that note, we have looked in the past after a C1 spinal injury client who was able to eat and drink, which is miraculous, really. But most C1 and C2 patients that we look after have a PEG tube, an enteral nutrition.

Next, hydration. Monitor fluid balance carefully as dehydration can worsen respiratory function.

Evidence. Proper hydration is crucial in spinal cord injury patients for respiratory health and preventing renal complications (McKinley et al., 2019).

Number 4, Physical Therapy and Mobility. 

Passive range of motion. While active mobility may not be possible, passive range of motion exercises can be performed to maintain joint flexibility and reduce spasticity.

Evidence. Passive range of motion exercises are beneficial in maintaining joint health and preventing contractures.

Now I can tell you, while active mobility may not be possible for some clients, I can assure you all of our spinal cord injury patients have community access, that means they’re out in the community almost every day.

Next, respiratory exercises. In some cases, patients can benefit from assisted cough techniques to help clear secretion from the airways, and that obviously includes cough assist machines or sometimes hyperinflation modes through a ventilator.

Evidence. Research supports the use of assisted coughing for spinal cord injury patients to maintain airway clearance (Bauer et al., 2020). What is on top of that is also, respiratory physiotherapy, including chest percussions, drainage, suctioning is all part of it.

Number 5, Monitoring and Health Maintenance.

Vital signs. Continuously monitor heart rate, respiratory rate, oxygen saturation, and blood pressure. Autonomic dysreflexia (a potential complication in spinal cord injury patients) should be closely monitored. Once again, vital sign monitoring is the skill for ventilated patient of a critical care nurse 24/7. That’s not even the skill of a registered nurse without critical care nursing experience. It goes back to the evidence-based Mechanical Home Ventilation Guidelines.

The evidence is that regular monitoring of autonomic function and immediate intervention if signs of autonomic dysreflexia occur is critical in preventing further complications. That is so true. Most, if not all C1 and C2 is spinal injury patients have autonomic dysreflexia and that needs to be prevented. If it can’t be prevented, it needs to be managed with strategies that work for the individual.

Next, blood glucose monitoring. Spinal cord injury patients are at an increased risk for insulin resistance and altered glucose metabolism, so monitoring blood glucose is important.

Evidence. Managing blood glucose levels is necessary to prevent complications in spinal cord injury patients (Tisch et al., 2019).

Number 6, Psychosocial and Family Support.

Mental health. Long-term ventilator and tracheostomy support and living with a spinal cord injury can lead to significant psychological stress. Address the client’s emotional needs and provide counseling as necessary. This also includes the family, of course, counseling, psychological support also needs to be offered to families in situations like that.

Evidence is that studies show that psychological support, including counseling, can improve outcomes in spinal cord injury patients and can reduce stress for families (Kennedy et al., 2018).

Next, Emergency Preparedness.

Clear protocols. Ensure there are clear protocols for emergencies such as ventilator failure, tracheostomy tube dislodgement, or respiratory distress. Have emergency contacts available and a backup ventilator if possible. What we do with Intensive Care at Home is clearly, we provide evidence-based care with critical care nurses who are trained and prepared for those emergencies and emergency contacting. Our organization means they can call nurse managers, they can call myself, or staff I should say, and the backup ventilator is always there if needed.

The evidence is clearly emergency preparedness is a critical component of home care for high-dependency spinal cord injury patients (Campbell et al., 2019). Once again it also comes back to the Mechanical Home Ventilation Guidelines on our website that are evidence-based.

Next, Regular Follow-up and Specialist Consultations.

Multidisciplinary teams. Regular follow-up with specialists, including pulmonologists, neurologists, and physical therapists is crucial for managing complex needs.

Evidence. Multidisciplinary teams are integral in managing spinal cord injury patients at home, improving care quality and outcomes (Bolliger et al., 2021). Obviously, multidisciplinary teams at the center here is the nursing team at home, the nursing team of critical care nurses that really are the glue that ties it all together.

Lastly, programs like the C1 and C2 spinal injury clients also need clinical care coordination. For example, our C1 and C2 spinal cord injury clients have 12 to 20 hours a week funded clinical care nursing coordinator support, which really makes the programs more stable, brings roster stability, brings client safety. They liaise with the hospitals, with doctors for appointments. They liaise with equipment supply. They coordinate with the family, with our nursing team, they coordinate with the client. They coordinate with the hospitals, with the specialists, and so forth, critically important.

So, by adhering to these evidence-based guidelines, the care for individuals with C1, C2 spinal cord injuries who are on a ventilator and tracheostomy home can be optimized, promoting their health and quality of life.

So, to wrap this all up and to put in context, 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 a long-term stay in intensive care for long-term ventilation, tracheostomy, Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), ventilation without tracheostomy, and tracheostomy without ventilation. We’re also providing Home TPN (Total Parenteral Nutrition), home IV potassium and home IV magnesium infusions, IV fluids, and IV antibiotics. We’re also providing ventilation weaning at home. We’re also providing central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as port management at home. We’re also providing nasogastric tube and PEG (Percutaneous Endoscopic Gastrostomy) tube management at home, as well as cough assist management at home, and also palliative care management 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 Area Health District, their in-touch program, saving approximately $2,000 per patient that we keep at home, instead of them going to an emergency department. 

We are, therefore, also in a position to cut the cost of an intensive care bed by around 50%. An intensive care bed costs between $5,000 to $6,000 per bed day. Our services costs between $2,500 to $3,000 per bed day and we’re freeing up the most sought-after bed in the hospital, which is the intensive care bed. But most importantly, we’re improving the quality of life for patients and their families which is a win-win situation for all stakeholders.

With Intensive Care at Home, we are currently operating all around Australia in all major capital cities as well as in all regional and rural areas. We’re an NDIS (National Disability Insurance Scheme) approved service provider all around Australia, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme in Queensland), as well as the Department of Veteran Affairs all around Australia. 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 currently 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 has achieved this high level of accreditation in the community and has created more intellectual property when it comes to Intensive Care at Home 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, which enables us to look after the highest acuity adults and children in the community in Australia safely.

If you’re at home already and you’re watching this, and you realize that you don’t have the right level of support, or if you’re stuck in an ICU long-term, including palliative care, or if your family member is stuck in an ICU long-term, I’ll give you a real-world example today. One of our first clients in the early days when we first got started with the service now over 13 years ago, was a client who was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, it’s dangerous and negligent having support workers looking after a client at home on a ventilator with a tracheostomy. That is like flying the airplane with the cabin crew instead of the pilot because anyone on a ventilator with a tracheostomy is at very high risk of medical emergencies or even dying if they don’t have a stable team of critical care nurses looking after them 24/7. This is actually evidence-based in the community and is documented in our Mechanical Home Ventilation Guidelines that are evidence-based that you can find on our website at intensivecareathome.com where it’s clearly documented that only and exclusively critical care nurses with a minimum of 2 years critical care nursing experience are safe to look after ventilation and tracheostomy, adults and children, at home safely.

Think about it, in an intensive care unit, in an ICU in a hospital, you wouldn’t have support workers looking after a critical care patient on a ventilator with a tracheostomy. So, why would anyone in their right mind would do that in a home care environment in the community? People have died because of a support worker model.

So eventually, this client and the ICU that he was going back to found out about us. He was living in this ICU. The ICU and the client pushed for our service with the funding body. We were proving our concept with this client very fast. When we worked with the client, we sent him intensive care nurses, 24 hours a day. He never went back into ICU ever again and we were proving our concept there very fast.  

As a side note and as a benefit for the funding body, we are cutting the cost of the ICU bed by 50%. It’s a win-win situation. We’re pretty much doing with our other clients. We are cutting the cost an ICU bed by 50%.

That also means we can do the same for you if you’re not safe at home or if you’re stuck in an ICU, and that obviously includes the advocacy for funding that goes along with it. We have always successfully advocated for our clients. Otherwise, we would not be in business. The same is applicable for those stuck in an ICU, similar to C1 and C2 patients, to what you’re looking for, reach out to us. We’ll make it happen for you as well. We can take you through the right steps and we will walk you through the right steps.

This is also why we are providing Level 2 and Level 3 NDIS Support Coordination. We have a team of NDIS Support Coordinators, and they have a wealth of knowledge. I’ve done an interview with Amanda Riches, one of our NDIS Support Coordinators, and I’ll put a link to an interview with Amanda in the written version of this blog below the video. 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 from another organization 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 what evidence to provide, I encourage you to reach out to us as well. 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.

If you are a critical care nurse and you’re looking for a career change, and you want to join a very progressive, dynamic, and high-performing and customer-centric team of critical care nurses in the community, we are employing hundreds of years of critical care nursing experience combined. If you are looking for a career change, we’re currently hiring for jobs for critical care nurses in Melbourne, Sydney, Brisbane, in Albury, Wodonga, in Bendigo, in Geelong, and in Warragul in Victoria. If you have worked in critical care nursing for a minimum of 2 years pediatric ICU, ED, and you have already completed a postgraduate critical care nursing qualification, we will be delighted hearing from you.

I have a disclaimer, because we are offering a tailor-made solution for our clients, which includes regular staff, our clients also do want the same staff coming over and over again because they are very vulnerable and very special, and that’s why we need regular staff. So, if you’re looking for agency work where you can come and go, this will not be the right fit for you. We are 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. 

If you are 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 you 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 and you get the same level of care, and you’re freeing up ICU beds.

If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, home TPN, of course, please reach out to us as well. We can help you eliminate your bed blocks very fast.

If you’re in the U.S. or in the U.K. 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].

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Thank you so much for watching.

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

Take care for now.