Podcast: Play in new window | Download

Why Cerebral Palsy Adults & Children on BIPAP (Bilevel Positive Airway Pressure) At Home Need 24/7 Critical Care Nurses (Evidence Based)!

Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home and where we also provide tailor-made solutions for hospitals and intensive care units at home whilst providing quality care for long-term ventilated adults and children with tracheostomies at home, otherwise medically complex clients at home adults and children, which includes BIPAP (Bilevel Positive Airway Pressure), CPAP (Continuous Positive Airway Pressure) at home, home tracheostomy care for adults and children that are not ventilated, Home TPN (Total Parenteral Nutrition), home IV potassium infusions, home IV magnesium infusions as well as home IV antibiotics. We’re also providing port management, central line management, PICC (Peripherally Inserted Central Catheter) line management, as well as Hickman’s line management and we also provide palliative care at home.

We have also sent, and we continue to send our critical care nurses into the home for emergency department bypass services. We have done so successfully for the Western Sydney Local Area Health District, their in-touch program.

Now, today I want to talk more about why especially cerebral palsy children need BIPAP sometimes at home and if they do need BIPAP, why they need critical care nurses 24 hours a day. I can give you some real-world examples from some of our clients, but also from the cerebral palsy website.

A lot of cerebral palsy children end up with scoliosis and therefore their respiratory health is very compromised and breathing problems may arise, and a lot of the clients that we’ve worked with over the years with cerebral palsy end up on BIPAP or on CPAP, predominantly on BIPAP. But several things contribute to the need for BIPAP including aspiration often, which is caused by the weakness or spasticity in the digestive tract muscles, may also cause the breathing problems and the aspiration. Also, gastroesophageal reflux, which often ends up for those children having a fundoplication.

Pneumonia is often caused because there’s an unsatisfactory cough and respiratory tract infections are often caused because those kids cannot clear their secretions, and those infections can readily develop into a pneumonia. So how can that be managed? Once again, it can be managed with deep suctioning. For example, some kids need a nasopharyngeal airway, but that’s not often enough, deep suctioning is not often enough. The tidal volumes when someone is on BIPAP or CPAP can be quite small. With the small tidal volumes (the volumes that are going into the lungs), that’s the only way really that adequate ventilation is established and maintained.

I’ll give you another example. One of our clients who’s a child at home on BIPAP for cerebral palsy. The client has a Glasgow coma scale of about 7 out of 15, which means the client is neurologically very compromised and therefore, also has issues clearing the airway. So, a nasopharyngeal airway is regularly used to clear the airway, that means a nasopharyngeal airway is inserted into the nose and then deep suctioning is often applied to clear the secretions. Furthermore, when BIPAP is on tidal volumes and minute ventilation is obviously monitored very closely, making sure that the tidal volumes are adequate for a patient’s weight and that’s usually 7 to 10 mls/kg, which means if a client is 40 kg times 10 mls, for example, that’s 400 mls per breath roughly.

In a clinical report we had from one of our nurses last week, all of a sudden, the volume dropped down to 50 mls, which is not enough for a patient in general, not for a teenager, in this case. So even though blood pressure was stable, the oxygen saturation of the client went down pretty quickly. Then, our critical care nurses working with the client established a patent airway with a Geudel airway and a jaw thrust. These are skills that only critical care nurses have by having worked in critical care for years and doing regular refresher trainings to have those skills. So, it’s only one of the ways we keep our clients safe at home, but in many other situations where if there wasn’t a critical care 24 hours a day, this client would have ended up in the emergency department potentially, would have even died.

We have evidence that whenever clients with BIPAP, tracheostomy, ventilation and so forth don’t have critical care nurses at home 24 hours a day, they have often died. We know of at least four clients that have died in recent years at home where the NDIS (National Disability Insurance Scheme) or other funding bodies weren’t funding the critical care nurse 24 hours a day and clients passed away during times when critical care nurses were not present.

For anyone interested to dig deeper there, please contact us. I can give you more information and provide you the evidence with everything that I’m saying here. Please bear in mind, this is a client that doesn’t have a tracheostomy so you think that the airway would be easier to manage for someone without a tracheostomy, but the reality is that even someone on BIPAP can become unstable and can have an unstable airway at any given moment, especially when their neurological condition is impacted, and their Glasgow coma scale is 7 out of 15.

Also, what we do and what I’m saying here, it’s all evidence based. When you look on our website intensivecareathome.com, there’s the Mechanical Home Ventilation Guidelines that are evidence-based. The evidence based Mechanical Ventilation Guidelines clearly suggests that only critical care nurses with a minimum of two years critical care nursing experience can safely look after a ventilated patient at home, adults and children. They need to have a minimum of two years critical care nursing experience, that is all evidence based. The Mechanical Ventilation Guidelines are a result of 25 years of Intensive Care at Home nursing in Germany and are also a result of Intensive Care at Home nursing in Australia since 2012. So, the evidence is overwhelming and clearly, if patients have died in the community in the past, that is something that mustn’t be repeated. The NDIS and other funding bodies must fund what is evidence based, not what’s based on perceived limited funding.

Furthermore, with Intensive Care at Home, we are the only service provider in Australia in 2024 that has actually achieved third party accreditation for Intensive Care at Home nursing. We have built unique intellectual property that we are bringing into the community, plus we are employing hundreds of years of intensive care nursing experience combined in the community because that’s how highly skilled our workforce is. That is unmatched of in Australia in 2024, brings us in a position to look after the highest acuity client safely with the quality framework in the community in Australia.

Now, 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 are an NDIS approved service provider all around the country, TAC (Transport Accident Commission) and WorkSafe in Victoria, iCare in New South Wales, NIISQ (National Injury Insurance Scheme) in Queensland. We are a DVA (Department of Veteran Affairs) approved service provider all around the country. We have also received, and our clients have received funding through departments of health, private health insurance, as well as public hospitals.

We are also providing Level 2 and Level 3 NDIS Support Coordination and we can help you and your family get the right funding for the right nursing care that you need. We have been involved with the advocacy for our clients from Day 1 successfully, otherwise we would not be in business.

I will post towards an interview that I’ve done with our NDIS support coordinator, Amanda Riches. You can have a look at the interview with Amanda below this video.

If you’re at home already in a situation like I just described with one of our clients where you have inadequate funding, inadequate support right in place, you’re getting admitted to hospital or your loved one gets admitted to hospital all the while, and you think your loved one is at risk of dying or you think you’re at risk of dying, please reach out to us urgently. We can help you with all of that.

If you are an NDIS support coordinator and you’re watching this and you’re looking for nursing care for your participants, please reach out to us as well. Or if you’re looking for funding for more nursing care and you don’t know how to advocate for it, please reach out to us. We’re also providing NDIS nursing assessments with our critical care nurses.

If you are a critical care nurse looking for a career change, we are currently offering jobs for critical care nurses in the home in Melbourne, Sydney, Brisbane, Albury, Wodonga, in Bendigo, Warragul, and Geelong in Victoria. If you have worked in critical care for a minimum of two years pediatric ICU, ED, and you have ideally completed a postgraduate critical care qualification, we will be delighted to hear from you.

Because we are offering a tailor-made solution for our clients, which includes regular staff, our clients want to have the same staff coming over and over again because they are very vulnerable and it’s all about building critical and crucial relationships and having regular and stable teams. So, if you are looking potentially for agency work where you can sort of come and go, this may actually not be the right fit for you because we’re looking to engage with you on a long-term basis and our clients want to engage with you on a long-term basis. So, it’s all about building critical relationships and longevity with our clients. So please only apply to us if you’re looking for long-term engagement.

If you’re an intensive care specialist or ED specialist, we also want to hear from you. We’re currently expanding our medical team. We can also help you eliminate your bed blocks in ICU, in ED for your long-term patients or for your regular visitors. We’re happy to help you take the pressure off your ICU and ED beds, and in most cases, you won’t even pay for it.

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

Lastly, 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.

Once again, contact us at intensivecareathome.com. Call us on one of the numbers on the top of our website or simply send us an email to info@intensivecareathome.com.

If you like my video, subscribe to my YouTube channel for regular updates for families with Intensive Care at Home and for families in intensive care. Click the like button, click the notification bell, share the video with your friends and families, and comment below what you want to see next, what questions and insights you have from this video.

I also do a weekly YouTube live where I answer your questions live on the show and you will get notification for the YouTube live if you’re a subscriber to my YouTube channel or if you are a subscriber to our email newsletter at intensivecareathome.com.

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.