HOW LONG SHOULD A PATIENT BE ON A VENTILATOR BEFORE HAVING A TRACHEOSTOMY

hi it's Patrick Hudson from intensive care hold on calm where we instantly improve the lives for families of critically ill patients in intensive care so that you can make informed decisions get peace of mind real power real control and so that you can influence decision making fast even if you're not doctor owners in intensive care this is another episode of your questions answered and in last week's episode answered another question from one of our readers and the question last week was how long does cardiac arrest patient stay in intensive care you can check out last week's question by clicking on the link below this video in this week's episode of your questions answered want to answer another frequently asked question by our dear readers at intensive care London comment the question this week is how long should patient be on ventilator before having trach EOS to me so your critically ill ofon has been admitted to intensive care and they require invasive or two ventilation with breathing tube also known as an endotracheal tube in their mouth and they are attached to ventilator and they are in an induced coma in order to be able to tolerate mechanical ventilation as it is rather uncomfortable and painful after few days of ventilation if your loved one is still unable to quote unquote wake up from the induced coma or if they are unable to wake up from natural coma therefore your critically loved one may still require the breathing tube or endotracheal tube for mechanical ventilation because they can't manage and protect their own airway through coughing or swallowing and they are also most likely still unable to breathe spontaneously furthermore the mechanical ventilation and the breathing tube or endotracheal tube may also be required to manage significant respiratory issue such as pneumonia ard is lung failure COPD or asthma just to name few if that's the case the breathing tube or endotracheal tube and mechanical ventilation is significant risk and safety issue that continues to require sedation and an induced coma most of the time you may have heard the doctors and the nurses talk about performing tracheostomy or tracheostomy for your loved one as your loved one is expected to require ventilation for few more days or even few more weeks as rule of thumb it is usually advisable to perform tracheostomy after about seven to fourteen days of ventilation if ongoing ventilation is expected and if slow and difficult weaning off the ventilator is expected there are other less common reasons as well that may lead to tract yours to me such as swallowing difficulties and sometimes difficult anatomy such as short neck that may lead to track EOS to me with swallowing difficulties they are often result of neurological conditions such as stroke seizures significant head or brain injuries and so forth or hypoxic brain injury as well but before you even want to look at tracheostomy as an option have look at another article on video that are Road about how to wean critically ill patient in intensive care off the ventilator and the breathing tube there you can make sure the intensive care unit is doing everything within their power to win your loved one off the ventilator in the first place and if you are watching this video on youtube click on the link below this video that will get you to website where you have access to all the links to our other articles and videos including the one how to win critically ill patient in intensive care off the ventilator and the breathing tube so let's quickly look at the main advantages of tracheostomy they are less sedation is required for your critically ill of one to tolerate mechanical ventilation as you may have seen your loved one may require fair amount of sedation and opiates opiates are also known as painkillers to keep them in an induced coma for ventilation and therefore keep them comfortable having breathing tube or endotracheal tube in the mouth is very uncomfortable and therefore require sedation and opiates in order to tolerate mechanical ventilation and the breathing tube or at tracheal tube with the tracheostomy sedation can literally be weaned off immediately after the tracheostomy has been performed and your critically in last one should be able to come out of the induced coma relatively quickly sometimes there are reasons why you're critically loved one may still require to stay in an induced coma even after tracheostomy has been performed however this would only be the case if your last one remains very unstable for the reasons such as raised intracranial brain pressures or mo dynamic instability such as low blood pressure or irregular heart rhythms or sometimes when on therapy called ECMO ECMO can sometimes also be performed on awake patients but again put link below this video towards ECMO so you can find out more information there next wheeling off the ventilator may be commenced the next day after the tracheostomy has been performed if your loved ones condition allows it may still be really relatively slow process however your critically loved one should be able to spend the first hour or so off the ventilator once the sedation has been taken away and an assessment can be made on how long it might take to wean your loved one off the ventilator next tolerating ventilation with attract Yasu means so much easier and doesn't require great deal of sedation so that your loved one should be able to at least try and mouth words and is able to move their lips also brushing teeth and performing mouth care is so much easier and it only improves the well-being for your loved one tracheostomy usually doesn't cause any pain unlike the breathing tube or endotracheal tube other related articles and videos around this topic that put below this video in links is how long can breathing tube or an endotracheal tube stay in and also what are the risks and benefits of trap you'll see me again if you're watching this on YouTube just click on the link below this video that will get you to our website to the written version of this blog and put the links to those articles in the written version you just need to click on the links next setbacks can be managed much easier with the tracheostomy for example if your critically ill of more needs to go back on ventilator after having time off the ventilator has been achieved it is easy to switch back and forth BT between spontaneous ventilation and mechanical ventilation and controlled ventilation often during the daytime patients are able to breathe without the ventilator but during the nighttime they do require mechanical ventilation and it is often required for rest periods next mobilization in chair is usually lot easier as well when having tracheostomy and you'll often may also be able to tolerate sips of water or tea or crushed ice and that improves your loved ones comfort and well-being as well there may also be times when even tracheostomy doesn't improve her loved ones condition in the short-term and your loved one may have hard difficult and prolonged time in intensive care because they're unable to be weaned off the ventilator sometimes despite rocky ostomy ventilation your critically loved one may be kept in intensive care for long-term ventilator dependency and that can be an extremely frustrating experience for both your critically loved one for you as family if this is the case you your family and your critically loved one need to be patient to point and you also need to start thinking about genuine alternatives if you are critically loved one stays in intensive care for too long again as rule of thumb everything about for weeks being ventilator dependent is far too long and general requires an alternative abroad approach in many countries such as Australia Germany and the United States many long-term ventilated adults and children with tracheostomy ZAR going home with the help of specialized and dedicated intensive home care nursing services have look at intensive care at home you can find more information at intensive care at home calm this service provides genuine alternative to long term stay in intensive care pitfall for tracheostomy especially for our readers in the United States is simply that after tracheostomy has been done patients are often being pushed out of intensive care into LTAC or long-term acute care facilities and they are quite simply disaster furthermore especially when it comes to tracheostomy in the United States the risk is that once tracheostomy is performed that the ICU wants to send your loved one to long term acute care also known as el tack this strikes disaster as eltechs are designed to save money but not to provide quality care for critically ill patients on ventilation if LTAC is mentioned as an option for your loved one after or before they have attracted us to mean your alarm bells need to go off and you will need to avoid LTAC at any cost can't tell you how many desperate families we have calling every week who want us to help them to get their loved ones out of LTAC we can help them achieve that with our one-on-one consulting and advocacy service and we have many success stories around that however more importantly we can help you advocate and make clinical argument to keep your critically loved one in the right environment in the first place which intensive-care the only place where patient can be safely looked after on ventilator with tracheostomy or with the breathing tube is intensive care period if you are not clear on this it could literally cost the life of your loved one the only alternative for patients on ventilation with tracheostomy is intensive care at home where highly skilled and specialized intensive care nurses provide 24-hour care in your home we loved one as genuine alternative to long-term stay in intensive care why I'm so glad you've asked because anybody on ventilator needs the skills and expertise of critical care nurse critical care doctor etc anything less than that is literally killing patients let me say this again one more time because if you're not clear on what is clinically required for your loved one on ventilator with tracheostomy it could literally kill your critically loved one because long-term acute care facilities or eltechs simply don't have the skills the expertise and professionalism to look after critically ill patient on ventilator with trach yours to me most of the time eltechs work with doctors and nurses who have no ICU skills and expertise hence they have no skills and expertise to look after ventilated patients the only place where patient can be safely looked after one event later with tracheostomy or with breathing tube is intensive care and you need to be very clear on that because it could literally cost the life of your loved one and unfortunately we have many families come to us when it's too late when their loved one is dying in LTAC so thanks for watching this video and the next question for you really is how can you become the best advocate for your critically ill loved one how can you make informed decisions get peace of mind control power and influence quickly whilst your loved one is critically ill in intensive care you will get to that all-important field of making informed decisions get peace of mind control power and influence when you download your free instant impact report now by entering your email below in your free instant impact report you will learn quickly how to make informed decisions get peace of mind real power and real control and how you can influence decision making fast whilst your loved one is critically ill in intensive care your free instant impact report gives you in-depth insight that you must know whilst your loved one is critically ill or is even dying in intensive care sign up and download your free instant impact report now by entering your email below in your free instant impact report you will learn how to speak the secret intensive care language so that the doctors and the nurses know straightaway that you are an insider and that you know and understand what's really happening in intensive care in your free report you will also discover how to ask the doctors and the nurses the right questions discover the many competing interests in intensive care and how your critically ill loved ones treatment may depend on those competing interests how to eliminate fear frustration stress struggle and vulnerability even if your loved one is dying you will get 5 mind-blowing tips and strategies helping you to get on the right path to making informed decisions get peace of mind control power and influence in your situation you will get real-world examples that you can easily adapt to your and your critically in loved 1 situation how to stop being intimidated by the intensive care team and how you will be seen as equals you will get crucial behind-the-scenes inside so that you know and understand what is really happening in intensive care and how you need to manage doctors and nurses in intensive care and it's not what you think thank you for tuning into this week's your questions answered episode and I'll see you again next week in another update make sure you also check out our blog section for more tips and strategies or simply send me an email to support at intensive care hotline comm with your questions also have look at our membership site intensive care support all four families of critically ill patients in intensive care or you can call me see international find international phone numbers on the top of the website also have look at our product section where you get boy books videos and audio recordings and where you can also get one-on-one consulting and advocacy with myself via Skype over the phone or via email this is Patrick hutsul from intensive care or Lancome and I'll see you again next week in another update