Should my mom have a tracheostomy or extubation at age 93 after aspiration pneumonia?

https://intensivecarehotline.com/blog/quick-tip-for-families-in-intensive-care-should-my-mom-have-a-tracheostomy-or-extubation-at-age-93-after-aspiration-pneumonia/

Quick Tip for Families in ICU: Should my mom have a Tracheostomy or extubation at age 93 after aspiration pneumonia?

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Hi, it’s Patrik Hutzel from intensivecarehotline.com with another quick tip for families in intensive care.

So, today I was talking to a longstanding client of ours in Los Angeles, and he’s got his 93-year-old mother back in ICU. She’s been having ICU readmissions over the last two years, and the ICU has always been very quick in saying, “Well, she’s not going to survive. She won’t have any quality of life. We should just stop treatment.” And her son has always been adamant that she wants to live and that she will get out of ICU. And she has always proven her son right, that with the right advocacy she can get out of ICU, go back home, and have some quality of life.

Now, this time round, she had another aspiration pneumonia. She ended up in ICU on BIPAP (Bilevel Positive Airway Pressure), but they had to intubate her, and she has been intubated for the last couple of days. She’s now in an induced coma on Precedex. She’s ventilated in an SIMV (Synchronized Intermittent Mandatory Ventilation) mode with a rate of 20, with a PEEP (Positive End-Expiratory Pressure) of 5, with FiO2 (Fraction of Inspired Oxygen) of about 50%. Her blood gases are average at best. She has some pleural effusions, but her heart is fine. She’s not on any inotropes or vasopressors. Her kidneys seem to be fine and they’re diuresing her to take fluids off the lungs and hopefully, wake her up in a few days and extubate her.

Now, the ICU’s already adamant that, again, she won’t have any quality of life, or she should have an early tracheostomy and then send her out to LTAC (Long-term Acute Care). I advised our client to keep pushing for extubation. A tracheostomy shouldn’t really be discussed before day 10 or day 14 in ICU, not waking up, and not being able to be extubated. So, it’s very early days and he should keep pushing along. He should keep advocating for the best care and treatment for his mother so she can go back home and have some quality of life without having a tracheostomy or without having her life support removed because even though she’s 93, she wants to live and otherwise, she would’ve informed her son that she doesn’t want to live and that she doesn’t want to go back into ICU. But that’s what she wants at this particular point in time.

So, we’ve advised the client what to do and he was very grateful for the advice. And now, he can start once again, asking the right questions with the intensive care team, and hopefully, get his mom from being intubated for an aspiration pneumonia to being extubated in the next few days, avoid the tracheostomy, and go back home very, very soon.

That is my quick tip for today.

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Thanks for watching.

This is Patrik Hutzel from intensivecarehotline.com and I will talk to you in a few days.