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Today's article is about, “Quick Tip for Families in ICU: Why Hemoglobin Levels Matter for Tracheostomy Collar Trials in ICU?”
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Quick Tip for Families in ICU: Why Hemoglobin Levels Matter for Tracheostomy Collar Trials in ICU?
“Why hemoglobin levels matter
for tracheostomy collar trials in ICU?”
My name is Patrik Hutzel from intensivecarehotline.com, where we instantly improve the lives for families of critically ill patients in intensive care, so that you can make informed decisions, have peace of mind, control, power, and influence so that your loved one gets best care and treatment always, even if you’re not a doctor or a nurse in
intensive care.
So, today’s question is from John, who says,
“Hi Patrik,
My father is now tracheostomy collaring. The ICU probably doesn’t want to do a tracheostomy collar if
hemoglobin is under 7. Do you have any thoughts on that?”
For context, John’s father had multiple strokes, he’s got seizures, and he’s also got a PEG (Percutaneous Endoscopic Gastrostomy) tube. He’s been suffering from this condition for multiple years. He’s a chronic patient, and he has gone in and out of ICU for a number of years.
So now, John, that’s a great and very important question that I know other families in intensive care will benefit from
as well. Let’s look at this step by step.
What is tracheostomy collaring? Tracheostomy collaring or tracheostomy collar trials is when a patient with a tracheostomy is taken off the ventilator and allowed to breathe through a tracheostomy mask or humidified oxygen. It’s a critical step in weaning someone off the ventilator with a tracheostomy.
So, why does hemoglobin matter? Hemoglobin carries oxygen in the blood. If hemoglobin is too low, generally speaking, under 7g/dL, it means the body and organs are not getting enough oxygen delivered. If someone like your father who has had multiple strokes, seizures, and has a PEG tube, oxygen delivery is absolutely critical. Low hemoglobin can make tracheostomy collaring
or tracheostomy mask, or sometimes it’s even called a tracheostomy shield, much harder, increase fatigue, worsen brain oxygenation, and even make seizures more likely.
So what is, generally speaking, ICU practice around hemoglobin and tracheostomy collaring? In most ICUs, if hemoglobin drops below 7, the patient will get a blood transfusion, especially if they’re symptomatic or struggling with
weaning when they’re going on the tracheostomy collar. Some patients can tolerate levels under 7, but for complex cases like your father’s, that’s often too risky. That’s why the ICU is probably hesitant to push forward with tracheostomy collaring, unless hemoglobin is optimized and that really can only happen with a blood transfusion.
So, what does that actually mean for your father? Well, the ICU
team may need to get a transfusion before continuing tracheostomy collar trials. Close monitoring during tracheostomy collaring is essential. Oxygen levels, heart rate, seizures, ABGs (arterial blood gases), all may
need to be tracked.
Going slow is better than rushing. Starting tracheostomy collaring too soon with low hemoglobin increases the risk of setbacks.
So John, you should ask the ICU team, what’s his current hemoglobin trend, and where is the drop in hemoglobin coming from? Is it a bleeding issue? Is he
bleeding internally? Is his bone marrow suppressed? Is his immune system suppressed? Is that why hemoglobin is dropping down? Do they plan to transfuse a unit of packed red blood cells before more tracheostomy collaring attempts? How are they monitoring him during the tracheostomy collar trials? How are they finding out the cause of the low hemoglobin? Are they getting hematology involved as the specialists?
This way you can advocate for your father’s best chance at successful weaning from the tracheostomy. I hope that helps.
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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.
