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 last week from Charlie was

My daughter in-law has been ventilated with tracheostomy for four months, how can we get her off the ventilator? (Part1)

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 question from one of our readers and the question this week is the next question from Charlie

My daughter in-law has been ventilated with tracheostomy for four months, how can we get her off the ventilator? (Part2)

This question from Charlie formed part of an email counselling/consulting session with me.

Charlie has also been interviewed on our podcast and you can listen to Charlie's interview with me here

INTERVIEW WITH CHARLIE ATKINSON WHO WAS A PATIENT IN ICU& LTAC FOR MORE THAN 12 MONTHS AND SURVIVED AGAINST THE ODDS! LISTEN TO CHARLIE’S INSPIRATIONAL STORY!

Charlie continues to share his daughter-in-law's situation

Hi Patrik,

what an understanding email you sent me. Thanks so much.

We are on the same page on so many issues even though I am thinking more broadly for a framework beyond the ICU, to the LTAC, to the Community, to Home.

Also the distinction between medical clinical and personal health is another way of framing the dichotomy.

I went ahead and purchased the 3 ventilator mistakes and look forward to this Ebook/ Video/ Audio recording.

Recommended:

FOLLOW THIS PROVEN SYSTEM TO AVOID THE 3 MOST DANGEROUS MISTAKES YOU ARE MAKING BUT YOU ARE UNAWARE OF, IF YOUR LOVED ONE REQUIRES LONG-TERM VENTILATION WITH TRACHEOSTOMY IN INTENSIVE CARE!

My challenge right now is to keep my daughter-in-law from progressively rapid weaning with the plan to get her off the ventilator and see if she stabilizes.

My thought is to set say 10 pm as the start time for ventilation and mostly uninterrupted sleep. Then let her wake up on her own without prematurely withdrawing support.

We are concentrating on daytime cardio-pulmonary activities to strengthen breathing. A winning weaning as opposed to deprivation approach!

The insurance game is different for my daughter-in-law than for me. The insurance stops the moment she is off the ventilator. She has another 100 days if the Doctors deem it medically necessary or appropriate after ventilation.

Our strategy is to not introduce the ventilator after 10 pm and not take her off till she awakens.

I have identified eight lifestyle competencies which have a personal responsibility but also a medical counterpart and perspective so that our Patient and Family 90 Day Protocol ends up with success in beginning to walk and progress on every dimension.

Your thoughts on going outdoors and getting sunshine as well as CNA type care are well taken and I will add those. Grooming!

I have been over to Quora and found you and Peter there too. Just great!

Happy to join in your adventure!

Charlie

Hi Charlie,

thanks for your email and your kind words.

You are right with your suggestions to let your daughter-in-law wake up in the morning in her own time and only then remove ventilation.

Uninterrupted sleep is very important too, however can be a big challenge in a noisy and busy ICU/LTAC.

It's one of the many issues for long-term ventilated Patients with tracheostomy in a clinical environment that they have lost their natural day and night rhythm, due to the noise and also due to the interruptions they experience 24/7 while they are sick and heavily dependent on care.​​​​​​​

Sleeping tablets, as well as Melatonin might help, but obviously the best option is to just go back to a natural and normal day and night rhythm.

That's why activities during the day are important too, so that your daughter in-law feels tired at night and can sleep.

Recommended:

THE 7 ANSWERS TO THE 7 MOST FREQUENTLY ASKED QUESTIONS IF YOUR LOVED ONE REQUIRES ONGOING MECHANICAL VENTILATION WITH TRACHEOSTOMY IN INTENSIVE CARE!

Again stimulation such as washes, showers, Physiotherapy, going outside etc… during the day  can help in this process as well.

From my experience as well, sometimes it’s worthwhile- especially in the early days when weaning off the ventilator- that Patients go back on the ventilator during the day as well, especially when they feel breathless or short of breath.

This only needs to be for short periods, because there is a huge psychological component when somebody is being weaned off the ventilator after months in Intensive Care/LTAC.

Keep in mind that some of the ventilator dependency might be psychological and therefore if Patients take steps that are too big in this process it might set them back. Therefore, your daughter-in-law might need to have the ability to rest on the ventilator as well during the day if she feels she needs to. It’s a bit like learning to walk again with the ventilator as the “crutch” so to speak.

You definitely want to see progress and you want to minimise the time spent on the ventilator, however it’s good to know how and when to use it if need be.

It sounds to me like you may have enough time to get your daughter in-law off the ventilator from an insurance point of view, however also keep in mind that the Doctors may want to keep her on it for as long as they can for financial benefit reasons.

I am not saying that they will, however you never know… I've seen enough during my time in ICU to know that nothing is impossible.

And you are absolutely correct to point out that there is so much more to this challenging situation than just the ventilator, the tracheostomy and the brain injury.

You are right on track to formulate a holistic care plan that is focusing on the bigger picture and the lifestyle competencies.

Part of my work that I am doing here in Melbourne, Australia is that I own a home care services for long term ventilated adults& children with tracheostomies and we provide Intensive Home care nursing services, as a genuine alternative to a long-term stay in Intensive Care.

We know we can do with INTENSIVE CARE AT HOME what LTAC(long-term acute care) provides in the USA. With my service INTENSIVE CARE AT HOME, there is no need for going to ICU/LTAC. We can successfully wean Patients at home off the ventilator and the tracheostomy. Therefore we are able to facilitate an earlier discharge home from Intensive Care as a genuine and proven alternative to a long-term stay in Intensive Care!

Much less noise and much less interruptions for Patients in their own home and also more cost effective! It’s a win-win situation!

INTENSIVE CARE AT HOME is a concept that has been successful in Germany for nearly two decades now and it's a genuine alternative to a long-term stay in Intensive Care for long-term ventilated adults& children with tracheostomies.

As far as I know there are no service providers in the USA, therefore your focus needs to be on improving your daughter in-law’s situation in the facility where she's currently at.

My suggestions are to keep doing what you are doing, I am certain you get lots of useful information from the Ebooks and it sounds like you have the right mindset anyway.

I would also like to- when you feel ready for it- do an interview so that you can share your story with our audience.

I publish a podcast where we interview families in Intensive Care and other people who have something interesting to share in this space.

Here is a link to the podcast and to relevant interviews.

http://intensivecarehotline.com/category/podcast

Please let me know if you have any other questions.

Kind Regards

Patrik