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 from our readers and the question was
I Am Not Happy with How They Treat My Wife with a Tracheostomy in LTAC. Can Intensive Care at Home Help in Getting My Wife Home?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Gladys, as part of my 1:1 consulting and advocacy
service! Robert’s wife is in LTAC with tracheostomy on a ventilator and Robert is asking if his wife can be safely weaned off from the ventilator in LTAC.
Can They Safely Wean My Wife Off The Ventilator in LTAC?
Robert: Well, I’m supposed to have a care meeting with them. And so I can certainly ask them. I certainly appreciate your help, but I think that I can certainly ask them those type of questions. Unless you think that you would have questions that I wouldn’t know.
Patrik: Yes. Very much so. But my first advice for families in a situation like that is, if you don’t know what questions to ask, they only tell you half of the story. When someone is in a situation like your wife, there are dozens of things happening simultaneously. I ask clients. I say, “Can you tell me what the ventilator settings are? Even better, can you send me a picture of the ventilator?” And at the moment that’s very difficult.
And then they tell me, “Oh yeah, she’s on a 50%. And I say, “Okay, that’s great, but there’s 10 other numbers that are important.” So the devil is absolutely in the detail. Yes, I can send you a list of questions. I can do that. But they tell you something back, but unless you can ask the next question straight away, you will only get half of the picture.
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Robert: I see.
Patrik: It’s a highly specialized area.
Robert: I see.
Patrik: It’s a highly specialized area. That’s all I can say.
Robert: I would love your help. But then what do you do with that information?
Patrik: Well, I guess it’s not so much what I do with that information, it’s more what you with that information, because that’ll probably tell you A, is she in the right place. B, is it realistic for her to come off the ventilator. C, are they doing the right things? Now,
here is probably the bad news. Most of the time I’m finding they’re not doing the right things in LTAC.
Robert: I know. Right.
Patrik: Right? You’ve got to go with what’s given. The LTAC at the moment, how far away is it from where you are?
Robert: About an hour and a half.
Patrik: Okay. So it’s not … Okay. All right. And the ICU where your wife was, was that close to you?
Robert: No. It’s 10 minutes from the LTAC.
Patrik: Okay. So not around the corner. No. Really from where you are?
Robert: No.
Patrik: Okay. At the moment, it doesn’t make much of a difference. I guess the difference is if visitation can start again. I guess that’s when location is probably very important.
Robert: Right. Would you try to move her to the other hospital that allows visitation?
Patrik: When you say other hospital, are you talking about another LTAC? Or are you talking about a hospital with an ICU?
Robert: I don’t know. I don’t know if insurance will pay for her to go back to a hospital.
Patrik: Okay. All right. Look, they may pay, but they may also … God forbid, if she has a setback. This is another thing that we’re finding very often when people are in LTAC, they’re often having setbacks. They end up back in ICU again, which could potentially be a blessing in disguise.
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Robert: Right.
Patrik: But at the same time, it’s another sign to me that you shouldn’t discharge patients from ICU too early. Again, it disrupts another care episode. It’s a-
Robert: I just feel sicker now. I’m so upset with myself.
Patrik: Look, it is what it is. And I understand that people trust hospitals and … I’ve worked in hospitals, in ICU for 20 years. And probably one of the reasons why I left eventually, because there’s too much negative things happening.
Robert: Yeah. Mm (affirmative), gosh!
Patrik: It’s so much bad things happening.
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Robert: So what do you think about the transport to the local hospital? Or not …
Patrik: Look, I think if you can visit her, I think any family contact is good. I’m very much-
Robert: Would that be better? If we’re going to risk her getting confused again, is me being … But I could be there with her then.
Patrik: I think it would be better. I think it would definitely be better. Bear in mind, any disruption of healthcare episode is always a risk. But I do believe the biggest risk is LTAC in and of itself. If you had had the ability to visit the LTAC before she was going there, you would have probably said, “No way!”
Robert: Yes. It looks nice and everything-
Patrik: Oh, I’m sure they’ve got a nice website. I’m sure they do.
Robert: Yeah. Exactly.
Patrik: But what’s happening behind four walls is different.
Robert: Right. Yeah.
Patrik: I don’t want to put more fuel on the fire. It’s very difficult if you have visitation rights. At the moment, it’s even more difficult.
Robert: What do you mean it’s difficult? You mean just being in the situation in general?
Patrik: Yeah, absolutely. Being in the situation in general is difficult, if you can be there physically. It’s even more difficult now with all the COVID restrictions.
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Robert: Right.
Patrik: So, it’s just very difficult for everyone. But where we could start, Robert, is we could start with just a call to the doctors or even to the nurse and find out what’s exactly happening. What are they doing? What are they not doing? Right?
Robert: Okay.
Patrik: And by talking to them, it’ll also give us an indication. Do they know what they’re talking about? Or do they not know what they’re talking about? At the moment, it sounds to me like, you’re absolutely in the dark of where your wife is at in terms of weaning.
Robert: I know that they were giving her, initially, two, four-hour breathing trials at the hospital, but since she’s been there and agitated and her heart rate has been high, they haven’t been doing it.
Patrik: Right. Most of the time when people go to LTAC, families are being told that they go to LTAC to be weaned off the ventilator.That’s what you’ve been told, yeah. In reality, that looks very different.
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Robert: Well, can I get her back in the hospital?
Patrik: Oh, look, you can advocate. You can definitely advocate. I guess she’s been there for two days.
Robert: Yes.
Patrik: If I was you, I would want to know what their plan is. What is their plan?
That would be my advice. They need to have a plan.
Robert: Right.
Patrik: And is that plan a sound plan?
Robert: Yeah. I would love to have you on that call. I’m supposed to having a care … I think they’re calling it a care meeting, something like that, where all the team was going to get together and talk with me. So that would be a perfect time for you to join.
Patrik: That would be a very good time, yes, because that would be the time to ask all the questions and find out what are they doing? What are they not doing? Also, another important question is, what are their success rates?
Robert: Yeah. They say 60% or something of getting off of it.
Patrik: Sure. That sounds good. But you still want to verify that. It’s all of that.
Robert: Yeah, absolutely. And then from there make decisions.
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Patrik: From there make decisions, because she’s been there for two days. They haven’t started the weaning yet, by the sounds of things. It’s too early.
Robert: Okay.
Patrik: But, like with anything, they need to have a plan. That’s the best I-
Robert: Okay. Did you have any people around that could do it in my area? Or, no? Or, where would you have?
Patrik: I’ll tell you where I am. I am in Melbourne, Australia.
Robert: Right.
Patrik: And, I’m talking to people all over the world every day, but mainly Australia, US and the UK and Canada. That’s where the market is. But I’m talking to people from your place in particular every day. And here, for example, here in Australia or in the UK, there are no LTACs. And I believe that’s a blessing. The first time I came across LTACs was when I started to talk to people in your place. I just thought, how can they send people to
an LTAC? And then by talking to LTACs and talking to people, I realized it’s just a better version of a nursing home. Here, for example, in Australia or in the UK, people are being weaned off the ventilator in ICU.
Robert: That’s much better much.
Patrik: That’s where you have all the expertise.
Robert: Right.
Patrik: Right? So, and obviously the system is different in your place. Right? And, that’s why I am a strong advocate that people should be weaned off a ventilator in ICU. Or, if that fails down the line, yes, then they should go home. But, again, you shouldn’t rush going home either. It’s only for someone that has proven that they can’t come off a ventilator. With your wife, just having had the trach 10 days ago, that’s
nothing.
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Robert: Yeah. So you think I should look into transporting them to another hospital? Or … if I can get visitation there? Or should I wait until we have this meeting?
Patrik: I think you should wait until you have more clinical information, because if you are going to another hospital, they want a referral and you need to find out more about the current situation. The way I would approach this meeting is almost like a head-to-toe assessment.
Robert: Yes.
Patrik: Right? If were to you let into this meeting and then I would almost ask them a head-to-toe assessment. What’s the brain doing? What are the lungs doing? What’s the heart doing? What are the kidneys doing? It is very important when patients are critically ill sometimes … Or most of the time, some of the major organs are impacted at least temporarily.
Robert: She looks good. Her creatinine and BUN and all that are good.
Patrik: They’re good? Good. Yeah. No, that’s good. Did they prone her?
Robert: They did when she was in ICU.
Patrik: Right. And that was effective?
Robert: Yes. And they didn’t have to prone her for too long.
Patrik: Okay. Good.Robert, I’ll tell you what I would do as the next step. If you wanted me on the call, I do charge a fee for that. I do send you some-
Robert: I didn’t hear. I’m sorry.
Patrik: Oh, sorry.
Robert: You do what for that? I’m sorry.
Patrik: Yeah. No, that’s okay. If you wanted me on the call with the doctors, I do charge a fee for that. I would send you an email with those options. There are separate options. You can choose whatever. The easiest option is to just start with an hour. You can always upgrade, but I do believe a lot can be done within an hour, just to give you a good base assessment and then advise of the next steps. But you got to keep in mind, ICU, LTAC,
ventilation, tracheostomy. It’s a highly specialized skill. And I believe if you’re not having someone on your team that can interpret information and can guide you of the next steps, they can tell you whatever they like.
Robert: I know. And you’re able to do all that? You’re able to interpret all of that and-
Patrik: Oh, absolutely. Look, I’m an intensive care nurse by background. I worked in intensive care for 20 years.
Robert: Okay, perfect.
Patrik: We are now running a company here in Melbourne. We are looking after ventilated patients at home, right? But I’ll send you some information. We are also running a consulting and advocacy service for families in intensive care. I don’t know how far your research has gone. If you take out Intensive Care
Hotline, I’ll send you a link to that. So there’s thousands of articles for families in intensive care. Just articles, videos, just to help families to make sense out of this chaos, because that’s what it is, really, unfortunately. When someone goes into ICU, its chaos, unfortunately, for families in particular.
Robert: It’s awful. Now I feel even worse. If she dies, I’m going to always think it’s my fault.
Patrik: No. It’s not your fault. It is what it is, Robert. You can’t change things as they happened. All you can do is look forward. That’s all you can do.
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Robert: Right? Okay, I’ll try.
Patrik: Look, Robert, I’ve got to go. What I’ll do is … look out for an email. I’ll send that email to you in the next half an hour or so.
Robert: Okay.
Patrik: And then you can get back to me what you want to do next.
Robert: Okay.
Patrik: And we’ll go from there.
Robert: That sounds great. And, once I get a time, I guess I’ll try to coordinate with you.
Patrik: Please do that.
Robert: Okay.
Patrik: Yeah.
Robert: Thank you so much.
Patrik: Pleasure, Robert. Stay positive. No matter what you do, stay positive. It’s not going to help to work yourself up about the past. Look forward.
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Robert: Okay. Thank you.
Patrik: Thank you. Take care.
Robert: Okay.
The 1:1 consulting session will continue in next week’s episode.
Kind regards,
Patrik
