Quick Tip for Families in Intensive Care: They Say The Ventilator’s Causing Damage After 24 Days But Won’t Do Surgery for a Tracheostomy?

They say the ventilator’s causing damage after 24 days in ICU on a ventilator with a breathing tube, but they won’t do surgery for a tracheostomy. Help!

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

We are always sharing updates and real-world situations for families in Intensive Care.

Now here’s the situation.

I see families in intensive care all the time, and it just doesn’t make sense. They’re telling you, the ventilator has been in for too long, it’s past 24 days now, it could cause permanent damage. But in the same breath, ICU team say, we don’t want to put him under anesthesia to do the tracheostomy, so, which one is it? Telling me the breathing tube is now dangerous, but you’re not willing to do what’s necessary to replace it with something safer, like a tracheostomy.

Let me break this down for you. When someone is ventilated with a breathing tube or endotracheal tube for more than 10 to 14 days, tracheostomy is generally the next logical step. I have made countless videos about this, that it’s usually a 10-to-14-day window, and research is supporting that.

A tracheostomy is more comfortable, easier to wean off the ventilator, and lowers the risk of long-term complications like vocal cord damage, tracheal stenosis, or ventilator associated pneumonia. If they’re saying we’ve gone past the safe point for ventilation, they’re technically correct, 24 days.

It’s way too long to have an endotracheal tube in. But if they don’t want to do the tracheostomy, then you’ve got to ask, what’s their plan? Are they just waiting for the patient to die? Are they potentially withholding necessary treatment, or are they being overly cautious with anesthesia because of other risks like instability or neurological issues. Even then, there are ways to do a tracheostomy safely at the bedside without general anesthesia. It can be done under local anesthesia with sedation. I’ve seen it happen many times, especially when someone is too unstable to go to the operating room, but often this is less about medical facts and more about hospital policies, risk aversion, and let’s be blunt, limiting costs or resources.

Here is why you need to question everything. You need to ask if the breathing tube is now unsafe, what’s the safer alternative? Why is the tracheostomy off the table if it’s clinically indicated? Can it be done under local anesthesia? What’s the risk of not doing it? If they don’t give you clear logical answers, it’s time to escalate and bring in a second opinion. Don’t let mixed messages and half truths decide your loved one’s future and fate.

 

This is why I do what I do at intensivecarehotline.com to help you hold intensive care teams accountable, ask the right questions, and make sure your family member is getting the care and treatment they need, want, and deserve.

Just as a bonus point, if they’re saying they don’t want to put your loved one under anesthesia to do a tracheostomy. So,