Hi, it’s 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, 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 in this series of questions from our client Robert and the question last week was PART 2 of
My 68 year old mother is in ICU with gastric perforation and she’s not “waking up” after the
surgery! Will she need a tracheostomy? (PART 2)
You can check out last week’s episode by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“, I want to answer the next question from our client Robert, which are excerpts from email counselling and consulting sessions with me and the question this week is
My 68 year old mother is in ICU with gastric perforation and she’s not “waking up” after the surgery! Will she need a tracheostomy?
(PART 3)
Robert describes his mother’s situation as follows with those series of questions.
Hi Patrik,
thank you very, very much for your thoughtful answers.
So far, her vital signs are looking stable.
The hospital team are recommending to do a tracheostomy tomorrow, and we are generally inclined to provide the consent because of the benefits. (It will have been 10 days since the intubation).
Questions for
you: The hospital is xxxxxx Hospital (ranked as one of the best hospitals in the U.S.). But, it is a teaching hospital, and as such, the consent form states that they can have a resident actually perform the tracheostomy — but with the attending surgeon present at all times. Is it reasonable/advisable for us to require/mandate that the actual operation be performed by the attending? Is that even an option?
By the way, a couple of answers to some of your previous questions:
- My mother is 68 years old.
- She’s diabetic
Still trying to find out which sedatives she was on as part of the surgery last week.
Many thanks
Robert
Here is my response
Hi Robert,
I know that xxxxxxx Hospital has a very good reputation and is one of the top ranking teaching Hospitals in the US.
In teaching hospitals sometimes residents perform the tracheostomy and from my experience it would be one of the more senior residents performing the procedure.
It’s always better to have a qualified specialist perform the tracheostomy of course, however the nature of the environment often dictates who is doing what.
Do
you now if they want to do the tracheostomy in the operating theatre or do they want to do it in ICU?
Most tracheostomies are getting done in ICU nowadays and as I mentioned in my previous email it’ll be a quick procedure within 30 minutes done by an experienced Intensive Care specialist.
Therefore I’m wondering are
they planning to do the tracheostomy in ICU with a registrar and an ICU specialist present or are they planning to do the tracheostomy in the operating theatre with a surgeon overseeing the procedure?
Also, if your mother is a privately insured Patient you may be able to choose who should be doing the procedure. Check out her level of cover and the small print.
I hope that helps Robert. Let me know if I can be of further assistance.
Patrik
Recommended:
Hi Patrik,
that does help, thanks.
- The procedure would be done in the ICU at her
current bedside, they do not need to take her to the OR. They have said it’s relatively simple and will take 30 min.
- The attending surgeon (the same one that performed the original surgery) will be supervising and present for the entire procedure. We liked her and trust her.
- The resident performing the surgery is on the tracheostomy team — so evidently has some experience.
I think we’re likely over-thinking the resident vs. attending issue given that this surgery is common and relatively straight-forward. So, we’re going to
talk to the attending surgeon in the morning, just to get some last minute comfort and have them do the tracheostomy tomorrow.
Many thanks
Robert
Hi Robert,
I think that given the overall situation with a couple of failed extubations, the prolonged stay in Intensive Care as well as the emergency abdominal surgery your Mom had in recent days you and your family are making the right decisions by consenting to a tracheostomy.
You have looked into it, you have done some
reading and watched some videos and you have been talking to the surgeons and the Intensive Care specialists.
By now you know what to expect and given that your mother still hasn’t woken up, the best course of action is a tracheostomy to reduce/minimize or even exclude sedation.
Related articles/videos
This increases chances of your mother becoming more alert and it also increases chances to reduce or minimize the needs for vasopressors or inotropes (such as
Norepinephrine/Noradrenaline or Epinephrine/Adrenaline) to maintain a physiological blood pressure.
By now you and your family also know that your mother will be way more comfortable with a tracheostomy compared to a breathing tube in her mouth.
A tracheostomy also gives Patients in Intensive Care more time to recover because of less need for sedation and therefore Patients tend to have less desired side effects that is related to sedation.
It also gives way more
leeway and options to wean your mother off the ventilator in her own time.
For now, I would advise to go with the flow and to consent to the tracheostomy, it’s the right thing to do!
