Quick Tip for Families in Intensive Care: Does My Ventilated Dad in ICU with Parkinson’s & Stroke Need a Tracheostomy & PEG (Percutaneous Endoscopic Gastrostomy) Tube? Can It Be Avoided?

“Should my dad with Parkinson’s disease in ICU have a tracheostomy and the PEG (Percutaneous Endoscopic Gastrostomy) tube? He’s currently intubated with a breathing tube.” That’s the question we’re going to answer today.

My name is Patrik Hutzel from intensivecarehotline.com, and this is another quick tip for families in intensive care.

This is actually a question from one of our members that we’re currently working with and we’re reviewing the medical records to advise our member so that they can make an informed decision, have peace of mind, control, power and influence, making sure her dad gets best care and treatment always.

So, let’s look at the evaluation of the medical records.

Your dad, who has advanced Parkinson’s disease, hypertension, which is high blood pressure, high cholesterol, chronic urinary retention, and a history of pulmonary embolism, was admitted on 6/18/25 after a mechanical fall that caused a subdural hematoma (which is a bleeding in the brain). He underwent craniotomy on 6/19 for evacuation of the bleed. Since then, he has shown signs of neurologic improvement, he is awake, intermittently following commands, tracking with his eyes, and has a Glasgow Coma Scale score of 10. Glasgow coma scale is a tool to assess your dad’s consciousness. You can read through the article below about GCS.

How to Assess Glasgow Coma Scale (GCS) in Adults and Children?

https://intensivecarehotline.com/questions/how-to-assess-glasgow-coma-scale-gcs-in-adults-and-children/

So, we continue in the medical record review.

Your dad was extubated on 6/20, so just one day after the craniotomy, but had to be reintubated, which means the reinsertion of the breathing tube, on 6/21 due to an inability to manage secretions, not because of respiratory failure. He remains on minimal ventilator settings (FiO2 30%, PEEP 5) with vital signs stable, his recent arterial blood gas on 6/25/25 with good oxygenation. Arterial blood gas (link below) test is to check how well his lungs are working.  On exam, his lungs are clear, breath sounds are equal, no signs of pneumonia, which suggests that his lungs are functioning well and that he may be a candidate for another extubation trial, with better secretion management. Extubation means the removal of the breathing tube. 

What is an Arterial Blood Gas Test (ABG)?

https://intensivecarehotline.com/questions/what-is-an-arterial-blood-gas-test-abg/

According to standard clinical protocols, a tracheostomy is typically only considered after 10 – 14 days of failed ventilator weaning or repeated failed extubation attempts. In your dad’s case, he is alert, showing neurologic improvement, and remains on minimal ventilator settings, which suggests he still has a good chance of coming off the breathing tube and the ventilator with the right support. Therefore, a tracheostomy is not necessary at this point in time.