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Today's article is about, “Quick Tip for Families in Intensive Care: My Mother's Been in ICU for Two Weeks with Two Failed Extubations, Does She Need a Tracheostomy?”
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Quick Tip for Families in Intensive Care: My Mother’s Been in ICU for Two Weeks with Two Failed Extubations, Does She Need a Tracheostomy?
“I want to know if my mom needs a tracheostomy after two weeks in ICU on the ventilator with a breathing tube or if she can be extubated?”
That’s a question we are having from one of our clients, and we’ll answer that question for our client today here in this video.
My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.
Our client has their mom in ICU for
about two weeks and she’s unable to come off the ventilator. He wants to know if a tracheostomy and the PEG tube (Percutaneous Endoscopic Gastrostomy) is the best next step for his mom, and
whether it’s in her best interest. So, let’s break this down for you.
So, at the moment, it is recommended that your mom undergoes a tracheostomy because she has been intubated for more than two weeks and she failed two trial extubations.
What’s a trial extubation? A trial extubation is that the breathing tube is taken out, but had to be reinserted, that’s then a reintubation. Unfortunately, those extubations failed. So, an endotracheal tube or a breathing tube should be in place for a maximum of two weeks. After that time frame, if your mom
still needs respiratory support and the breathing tube, then a tracheostomy is advised.
Your mom’s
failed extubations were due to airway swelling or airway edema, also known as stridor, and carbon dioxide retention. She’s not sedated, awake, alert oriented, and following commands, but she has respiratory weakness and hypoventilation, which is breathing that is too shallow or too slow to meet the needs of the body. Tests were done to check for neurology related causes, such as brain CT (Computed Tomography), MRI (Magnetic Resonance Imaging), and EMG (electromyography), they were all
negative.
Autoimmune workup results from lumbar puncture are still pending. The stridor was resolved with prednisolone, and that is a steroid.
They can resume the ventilation weaning after the tracheostomy as tolerated and hopefully decannulate the tracheostomy thereafter. As for the impact of intubation to the vocal cords, it can cause inflammation, laryngeal edema, and in rare cases, vocal cord paralysis. However, in your mom’s case, she had a stridor after removal of the breathing tube, not during intubation. But prolonged intubation has an impact
on the quality of her voice and ability to breathe. She may be very dependent on a ventilator, so more lung muscle strengthening is needed for her to be accustomed to breathing on her own.
In addition, her intake and output should be monitored. If she has too little output, the excess fluid in the body will accumulate in her lungs, making her breathing difficult. She needs repeat chest X-rays to check for pulmonary effusion or lung collapse or pulmonary edema.
It is also important to have arterial blood gases to check the oxygen and carbon dioxide levels in her blood. It is suggested to have pulmonology consult and input regarding hypercapnic respiratory failure. Hypercapnia means high CO2 or carbon dioxide. If carbon dioxide retention is not
related to neuromuscular disorder or central nervous system depression, then it could be purely respiratory in nature. They can rule out chronic obstructive pulmonary disease, also known as COPD, or other respiratory issues.
As for a PEG tube, this can be postponed. Tracheostomy airway management is more important. As of now, if a tracheostomy and PEG are done, she can be easily transferred to an LTAC, as these are the requirements for an LTAC admission, and you should avoid that at all costs.
It has been reported that she has no
swallowing issues. She denies dysphagia, so it’s better to have her swallowing tests and remove the nasogastric tube if there is no contraindication rather than placing a PEG tube. She’s awake, conscious and alert with no swallowing
problems, so why not try to allow her to eat gradually through the mouth after the tracheostomy? This way she can taste the food and have her appetite back.
The sooner she can get back to normal, the better.
I hope this information helps, and I hope that we helped you to make decisions that are actually
in the best interest for your mom.
I have worked in critical care nursing for 25 years in three different countries, and I’ve been consulting and advocating for families in intensive care since 2013 here at intensivecarehotline.com. I can very confidently say that we have saved many lives for our clients in intensive care. You can verify in our intensivecarehotline.com
testimonial section at intensivecarehotline.com and you can verify it on our intensivecarehotline.com podcast section where we have done client interviews, plenty of them.
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Thank you so much for watching.
This is Patrik Hutzel from
intensivecarehotline.com, and I will talk to you in a few days.
Take care for now.
