Quick Tip for Families in Intensive Care: What Questions Should You Ask the ICU Team When Advocating for a Tracheostomy for Your Loved One?

“What questions should you ask the ICU team when advocating for a tracheostomy for your loved one with a breathing tube?” That’s what I want to talk to you about today because this is a question we get quite frequently from families in intensive care.

My name is Patrik Hutzel from intensivecarehotline.com, where we help families of critically ill patients in intensive care to make informed decisions, have peace of mind, control, power, and influence, even if you’re not a doctor or a nurse in intensive care, so that your loved one gets best care and treatment always.

So, let’s get right into it. If your loved one has been in ICU for more than 7 to 10 days and is still on a ventilator with a breathing tube or an endotracheal tube, you’re probably being told that your options are limited. You might be hearing things like number 1, “They’re not waking up.” Number 2, “They’ll never come off the ventilator.” Number 3, “There’s no ‘quality of life’” or even worse, “We should consider comfort care or withdrawal of treatment,” which is basically a death sentence.

But that’s not the full picture, and that’s why I’m here to give you real advocacy tools, the kind of questions you need to ask now to stop the ICU from giving up too soon and to give your loved one the time and treatment they need. So let’s get into it.

So, number 1, why is my loved one still on the breathing tube? Start here. You need to find out the real reasons why they haven’t been extubated. Extubation is the removal of the breathing tube. Is it a respiratory issue? Is it a neurological delay? I.e. Is your loved one not waking up despite being off all sedatives and opiates? Therefore, is sedation still running? Are opiates still running? Are they potentially not strong enough to get extubated just as yet? The ICU team must tell you clearly why your loved one can’t come off the ventilator.

Here is a bonus question for you in this situation. Has the ICU team done everything beyond the shadow of a doubt to get your loved one off the ventilator and the breathing tube and avoid the tracheostomy or comfort care? It’s a very important question. I have made a video about this, “How to wean a critically ill patient of the ventilator and the breathing tube?” I will insert a link to that video right here.

Number 2, what’s your plan if my loved one can’t be extubated in the next few days? This is a crucial question. If the ICU team doesn’t have a plan, you need to create one with them, and that plan should include tracheostomy if your loved one is medically stable, avoiding a “one-way extubation” if there’s a risk of failure, and stopping sedation to assess neurological function properly.

The other thing that we’ve learned after having worked in intensive care and critical care for over 25 years in three different countries, where I also worked as a nurse manager for over 5 years, ICU teams are not even telling you half of what’s going on.