What Are Options for Ventilated Patients in ICU with a Breathing Tube & ABI Needing a Tracheostomy?

https://intensivecareathome.com/what-are-options-for-ventilated-patients-in-icu-with-a-breathing-tube-acquired-brain-injury-abi-needing-a-tracheostomy/

What Are Options for Ventilated Patients in ICU with a Breathing Tube & ABI Needing a Tracheostomy?

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Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies at home and where we also provide tailor-made solutions for hospitals and intensive care units at home whilst providing quality care for long-term ventilated adults and children with tracheostomies at home, otherwise medically complex adults and children at home, which includes Home BIPAP (Bilevel Positive Airway Pressure), Home CPAP (Continuous Positive Airway Pressure), as well as home tracheostomy care for adults and children at home that are not ventilated. We also provide Home TPN (Total Parenteral Nutrition), home IV potassium infusions, home IV magnesium infusions, as well as home IV antibiotics. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management as well as Hickman’s line management, and we also provide palliative care services at home.

We’re also sending our critical care nurses into the home for emergency department bypass services. We have done so successfully in the past for the Western Sydney Local Area Health District, their in-touch program.

So, today I want to talk about what options there are for patients with hypoxic brain injuries in ICU for example that can’t come off the ventilator successfully. Part of what we do with Intensive Care at Home, we have a consulting and advocacy arm for families in intensive care and you can find more information at intensivecarehotline.com. There, we provide an in-depth professional consulting and advocacy service for families in intensive care. We’ve been doing that from Day 1 since we started Intensive Care at Home. So out of that, there are families in intensive care that contact us right away when they have a loved one in intensive care. They’re looking for options in case their loved ones can’t come off the ventilator and so forth.

So, this week, we were working with a client through our consulting and advocacy at intensivecarehotline.com who had a 36-year-old brother and husband in an ICU in Australia, to be more precise.

So, patients not waking up initially had a GCS (Glasgow coma scale) of 3 or 4, was barely doing anything, looked like he was in a vegetative state even after sedation and opiates came off, but he was slowly but surely showing signs of getting more awake. He was showing signs of thrashing around, opening eyes, no purpose for movements just as yet, but definitely showing signs of getting more and more awake.

The question inevitably came up, what is next for this gentleman? Should he be extubated and not be reintubated? Should it be a one-way extubation with a withdrawal of treatment? Could it be a tracheostomy in case he can’t come off the ventilator? There were plenty of discussions going on between ICU and the family, and we were guiding the family as their advocate saying, “Look, if he needs a tracheostomy, then he can go home with Intensive Care at Home.” And the ICU was saying, “Well, he won’t have any ‘meaningful recovery.’ He won’t have any ‘quality of life.’” Well, I object to all of that because what is not meaningful for an ICU team may be very meaningful for the family and for the patient.

Continue reading at: https://intensivecareathome.com/what-are-options-for-ventilated-patients-in-icu-with-a-breathing-tube-acquired-brain-injury-abi-needing-a-tracheostomy/