Hi, it’s Patrik Hutzel from intensivecarehotline.com , where we instantly improve the lives of Families of critically ill Patients in Intensive Care, so that you can have peace of mind, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive
Care!
This is another episode of “your questions answered” and in last week’s episode I answered another question from our readers and the question
last week was
MY HUSBAND OF 24 YEARS WAS IN ICU AFTER CARDIAC ARREST
AND HE DIED! IT WAS HORRIBLE AND I THINK HE COULD HAVE BEEN SAVED WITH A MORE POSITIVE INTENSIVE CARE TEAM!
You can check out the answer to last week’s question by clicking on the link here.
In this week’s episode of “your questions answered” I want to answer another question from one of our readers and the question this week is from Heather whom I have consulted previously and as her Partner continued to be in Intensive Care, you will
see more of her questions being answered over the next few weeks!
Previous questions(Part 1 and Part2) from Heather you can find answered by clicking on the link here and here.
Today, Heather asks
MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO?
(PART3)
Hi Patrik,
thank you for your detailed response.
Ok Here is the deal. I have been asking the nurses about the tracheostomy and PEG(=Percutaneous Endoscopic Gastrostomy)
deal.
How long do they think he'll have it or even will they stay his physical therapy right away?
They all say oh I don't know we don't deal with that part
here. Once he gets the tracheostomy he'll be moved to a long term care facility (LTAC).
My partner did well in the weaning trial today but there concern is him not following commands and therefore they are afraid he won't be able to protect airway constrictions.
He won't extubate until his father comes here and he explains to him that his wind pipe or whatever may be too swollen to re-intubate and he would have to do a crank or bedside tracheostomy.
I have read about tracheostomies on your
website and since their concern is about his being able to protect his airways, which is a risk with all extubations.
If he's passing the weaning trials now then with a tracheostomy they will be able to see right away if he's able to do that and they already know whatever it is they know by doing the spontaneous
breathing on the ventilator which he's been doing and passing, just to exercise his lungs and he should be able to be off the ventilator immediately really if it's just about protecting his airway.
So the physical therapy of his recovery may be lengthy. Do you think they want to do a tracheostomy simply to just make a bed available?
I think he will be able to breathe just like he
was before and he didn't have his problems even diagnosed or had even much less diagnosed and has been treated. I hate for them to extubate and then need to re-intubate and have to do the tracheostomy, because I really think he can pass it, unless he's fighting too hard to get out of sedation.
I truly feel he can do this, but I
don't want a life threatening risk. I also don't want them to perform an unnecessary surgery just so they can pawn him off on another facility.
It seems like a Mexican stand off, his dad said no tracheostomy until he tries extubation and the doctor just letting him sit here and wait when he doesn't have to have consent to
extubate.
Last week I was concerned they would extubate him before he had a surgery that he
would need to be intubated for and the surgeon then said it was worse to keep him on a ventilator unnecessarily than to re-intubate for that surgery.
Different people have different opinions and say different things and no one is consistent.
The nurse is yelling at me because I think the only risk of the extubation is the same as with every extubation. I realize the risk is greater in my partner’s case do you think it
is too much of a risk?
Many Thanks
Heather
Hi
Heather,
congratulations that the nurses keep yelling at you.
Seriously, it shows that you are standing your ground, because it
looks like the nurses know they are dealing with someone who is standing their ground and you are fighting for what you believe in! Well done!
Don't let the doctors or the nurses intimidate you, no matter what.
Two related articles that you need to check out as it relates to intimidation and being perceived “too demanding":
Next, I do strongly believe that they need to do a trial extubation, the way they can do this is by deflating (=taking the air out of the balloon that blocks the Breathing tube) and find out whether there is air bypassing the tube and if your partner can breathe when the air has been let down, that's a sign that they can at least do a trial
extubation.
I do strongly believe that one of their reasons why they do want to perform a tracheostomy is to free up their beds. But in order to really find out you have to confront them, ask them the questions directly, you know you need to ask them and gauge their reaction.
This is the only way to get peace of mind, control, power and influence quickly!
The fact of the matter is that once your partner has the tracheostomy and will be moved to a long-term care facility you don't know how long he'll be there!
If your partner gets extubated and moved out of ICU, his hospital stay, as well as his ICU will be minimised big time.
Long-term care facilities are what the name implies. Long-term
care.
I would imagine you want your partner out of hospital as quickly as possible.
Performing a tracheostomy and going on to long-term care may well mean big bucks for the hospital, whereas extubating and leaving an expensive ICU bed may mean no
big bucks for the hospital.
I can't diagnose from afar, but you need to have a heightened awareness of what may be going on "behind the scenes" and by you becoming more "difficult and demanding" you may well get what you want!
Don’t do what other people do, because you’ll get what other people will get!
On the other hand a tracheostomy may well be the right thing to do, as they may be able to take him off the ventilator relatively quickly.
Again, I can't diagnose from a distance however you need to be clear of what you want and what you know is in the best interest of your partner.
I would still strongly argue for a trial extubation first and then do a tracheostomy if he fails. Again airway swelling can be checked by deflating the breathing tube balloon and find out whether he can bypass the tube and breathes spontaneously.
The other question is why is he not obeying commands? Is there something else going on?
A prolonged hospital/ ICU stay is making people more likely to "not wake up", but why is your partner not waking up?
Related articles:
I hope that helps Heather and please let me know if I can assist you further in this challenge!
You are providing a lot of value to other families in Intensive Care by staying strong and encouraging them to stand their ground and by doing their own research.
Take care
Patrik
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