Hi there!
Today’s article is about, “Should My Dad in ICU have
the Tracheostomy Removed or Is it Too Early? Quick Tip for Families in ICU”
You may also watch the video here on our website https://intensivecarehotline.com/ventilation/should-my-dad-in-icu-have-the-tracheostomy-removed-or-is-it-too-early-quick-tip-for-families-in-icu/ or you can continue reading the article below.
Should My Dad in ICU have the Tracheostomy Removed or Is it Too Early? Quick Tip for Families in ICU
If you want to know what to do if your loved one should have the tracheostomy tube out or not,
stay tuned. I will answer that question for you today.
My name is Patrik Hutzel from intensivecarehotline.com and I have another quick tip for families in intensive care.
So currently, we are working with a client in the U.K. who has their father in ICU. The ICU team wants to take out
the tracheostomy tube. He’s been weaned off the ventilator now and they want to send him out of ICU as quickly as possible. He’s been weaned off the ventilator for about a couple of weeks, but he’s still having the tracheostomy cuff up and down at times because they don’t think he’s safe to manage his secretions and manage swallowing.
So, the intensive care team is pushing to
take the tracheostomy tube out but, obviously, the family that we’re working with reached out and said, “Do you really think he’s ready if they’re still putting the cuff up and down at times?” and I said, “No, he wouldn’t be ready because if they’re putting the cuff up, then that means he’s
not able to swallow his secretions.”
So, things that need to happen for someone to have the tracheostomy tube removed and I discussed that in other videos as well. But in a nutshell, patient needs to be awake, obeying commands, following instructions, be able to swallow, be able to cough to the point where they can cough up their own secretions. The tracheostomy tube should be capped so that the
patient is forced to breathe through the nose and the mouth, and there should be minimal secretions as well. Once those boxes are ticked then a tracheostomy can be removed. Ideally, the patient is also off oxygen. So those are the boxes that need to be ticked.
This situation given that the cuff is not down all the time, it’s a risk. Also, the patient is still on inotropes and vasopressors, i.e., he’s still hemodynamically unstable, making it more likely for him to deteriorate and the risk is fairly high.
Now, I’m all for removing tracheostomy as quickly as possible, if you can. But the other issue here is that they are telling the family, “Well, we’re taking out the tracheostomy, but if he needs it back in, we won’t put it back in.” Well, that in my book is not doing what’s in the best interest of a patient, which is to live.
Furthermore, the patient is awake and can communicate. So, why not ask the patient what he wants rather than telling the family we won’t put it in?
The NHS (National Health Service) is broken as it is, that just further underlines how broken the NHS in the U.K. is in terms of that they’re not doing what’s in the best interest for patients and families and they’re putting it in this euphemistic light
of, “Well, it’s “in the best interest” for your father not to live anyway because he’s only suffering.” Well, clearly, the client says my dad is awake and he wants to live. It’s unbelievable the judgment that’s coming from some intensive care teams in terms of what their perception is about who should live and who should die. It’s not up to them.
Their job is to help people and help people what they
perceive is in their best interest, not what’s in the intensive care teams’ best interest, which is to free up beds and free up staff so they can look after the next critically ill patient because an ICU bed is the most and highly sought after bed in a hospital.
So, I hope that clarifies today and what I advise the family to get it in writing from the intensive care team that if they think it’s
valid to take out the tracheostomy tube and it fails, well, let’s put it back in and let’s give it another go at another time. Let’s keep mobilizing this gentleman if he can while he’s on inotropes. But let’s treat the
infection that he’s got now.
Let’s get him off the inotropes and then start all over again.
Recovery in intensive care can take time. It’s a marathon, not a sprint.
I’ve made countless videos about that
over the years that it’s a marathon, not a sprint.
I worked in critical care for nearly 25 years in three different countries where I worked as a nurse manager in ICU for over 5 years. We’ve been consulting and advocating here at intensivecarehotline.com since 2013.
We have
saved many lives by with our consulting and advocacy. You can verify that on our testimonial section. You can also verify that on our podcast section where we’ve done some client interviews.
Because we get so many questions, and we want to help as many families in intensive care as possible, that’s why we created a membership for families of critically ill patients in intensive care. You can become a member if you go to intensivecarehotline.com and you click on the membership link or you go to intensivecaresupport.org directly. In the membership, you have access to me and my team, 24 hours a day, in the membership area and via email and we answer all questions intensive care related.
You also have exclusive access to 21 e-books and 21 videos that I have
personally written and recorded sharing all my more than two decades worth of experience in intensive care with you so that you can make informed decisions, have peace of mind, control, power and influence, making sure your loved one gets best care and treatment.
I also offer one-on-one consulting and advocacy over the phone, Skype, Zoom, WhatsApp, whichever medium works best for you. I talk to you and your families directly. I talk to doctors and nurses directly and I handhold you through this once in a lifetime experience that you can’t really afford to get wrong. When I talk to doctors and nurses directly, I ask all the questions that you haven’t even considered asking but must be asked when you have a loved one in intensive care. I leave no stone unturned all
with the goal of you making informed decisions, having peace of mind, control, power, and influence. I also represent you in family meetings with intensive care teams so that you have a strategy when you go into those meetings, and you don’t get walked all over.
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Thanks for watching.
This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.
Take care for now.
