Hi there!
Today’s article is about, “Quick Tip for Families in Intensive Care: Can a family in ICU be Coerced to Withdraw Life Support While Patient Wants to Live a Violation of Rights?”
You may also watch the
video here on our website https://intensivecarehotline.com/ventilation/quick-tip-for-families-in-intensive-care-testimonial-from-another-very-happy-intensivecarehotline-com-member-and-client/ or you can continue reading the article below.
What are Indicators to Use Uncuffed vs Cuffed Tracheostomy & Is There a Difference in the Community?
Today, I want to talk about uncuffed versus cuffed tracheostomies and how it impacts how we’re looking after them at home.
My name is Patrik Hutzel from intensivecareathome.com. This is another quick tip for our clients and people that are interested in what we’re doing.
So, what are the
indicators to use an uncuffed versus a cuffed tracheostomy? That’s number one. Then, is there a difference to look after a client in the community that has a cuffed or an uncuffed tracheostomy? I will break all of that down today.
The decision, number one, to use a cuffed versus uncuffed tracheostomy depends on several clinical factors. So, here’s a clear breakdown of when each type is typically used. When are cuffed tracheostomy tubes
used? Of course, when a patient is actually ventilated because it prevents air leaks and ensures adequate ventilation.
Aspiration risk, the cuff helps protect the airway from secretions and gastric contents. Poor upper airway
protection, if the patient has reduced consciousness or impacts swallowing reflex. Lung hygiene, when frequent suctioning is needed, especially in patients with poor cough.
Also, let’s have a look at the tracheostomy here, so that you can actually see what that looks like. This is a tracheostomy. This is the actual cuff, you can see the cuff going up. So if the cuff is down, that means when a patient is ventilated, the air will just
blow out and won’t stay in the lungs. So again, this is what a tracheostomy looks like. This is the actual cuff going up, now cuff going down.
So, that leads me then to an uncuffed tracheostomy. But as you can also see, when the cuff is going up, that’s what I mean when I talk about that it protects the lungs from aspiration and saliva going down into the lungs. Let’s look at an uncuffed tracheostomy tube.
What are the indications? Indications are, for spontaneously breathing patients not on mechanical ventilation, low aspiration risk when airway protective reflexes are intact. Pediatric patients commonly used in children to avoid tracheal damage from cuff pressure. Speech and swallowing
assessment allows more natural airflow and voice production during weaning.
Additional considerations during weaning from ventilator patients often transition from cuffed to uncuffed or cuff deflated tubes as they improve. Tracheal damage risk, long-term cuff tubes should be monitored for pressure injuries.
Again, I’ll show you that once again. This is a tracheostomy. So, an uncuffed tracheostomy is basically
just with the cuff down, but you would have a tracheostomy tube that doesn’t even have a cuff where you can inflate like I do here now. So, I hope that explains to you.
Does it make a difference in how to look after them in the community? Not really, because you still have an artificial airway. Both uncuffed and cuffed tracheostomies are artificial airways, and they need management by critical care nurses, 24 hours a day, as is
evidenced in the Mechanical Home Ventilation Guidelines that you can see and read on our
intensivecareathome.com website. Those guidelines are evidence-based. You still need critical care nurses, 24 hours a day, for both situations.
So, I hope that explains to you cuffed versus uncuffed tracheostomy. Chances that an uncuffed tracheostomy is coming out is much higher than a cuffed tracheostomy is coming out, because patients are already off mechanical ventilation which is one ingredient, of course, for a tracheostomy to be removed or coming close to removing. But if a patient can’t swallow or is unable to swallow, they still need a cuffed tracheostomy even if they are off the
ventilator simply because of aspiration risk.
So, with Intensive Care at Home, we are currently sending our ICU and critical care nurses into the home, 24 hours a day. We are providing the following:
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 .
This also means, we’re 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 ICU bed. Most importantly, we’re improving the quality of life for patients and their families which is a win-win situation for all stakeholders. Of course, quality of life is much improved surrounded by families instead of staying in an intensive care unit.
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 (DVA) 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 level of accreditation since 2012. No other provider in Australia has achieved this high level of accreditation in the community and has created more intellectual property when it comes to Intensive Care at Home nursing 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, or you’re stuck in an ICU, like in our case study today or if you’re going to the hospital and ED all the time and you realize that you don’t have the right level of support, I’ll give you another tangible and real-world example
today, very similar to what I gave you a minute ago. One of our first clients when we first got started over 10 years ago in 2012, was a client who was at home initially on a ventilator with a tracheostomy with a support worker model 24/7. Of course, support workers are not equipped to look after a ventilated and tracheostomy client. That is dangerous and it’s negligent. Having support workers looking after a client at home on a ventilator with a tracheostomy 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 24/7 or even at risk of dying if they don’t have a team of critical care nurses looking after them 24/7 at home. This is actually evidence-based and is documented in our Mechanical Home Ventilation
Guidelines that you can find on our website at intensivecareathome.com.
Think about it, in an intensive care unit in a hospital, you wouldn’t have support workers looking after your critically ill loved one or after any critically ill 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?
So, this client found out about us eventually and the ICU that he went back to all the time also knew about us and eventually reached out to us. We were proving our concept with this client very fast. When we worked with the ventilated and tracheostomy client, we sent him intensive care nurses, 24 hours a day. He never ever went back into ICU ever again as long as we worked with the client. We were proving our concept there very fast.
We can do the same for you if you’re not safe at home which 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 our case study today or if you’re going back to ED all the time, reach out to us. We’ll make it happen for you as well. We can take you through the right steps including NDIS or other
funding bodies and the advocacy that needs to go along with it.
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. We’re also providing TAC case management and WorkSafe case management in Victoria.
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 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 do have a disclaimer though, 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 so vulnerable and so 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.
If you’re a hospital executive watching this and you have bed blocks in your ICU, ED, and respiratory wards, or home TPN, 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 info@intensivecareathome.com.
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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.
