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Intubation vs tracheostomy (elderly woman)

Posted: Mon Dec 07, 2015 1:42 am
by curiousgeorge
You recently helped an elderly relative of ours avoid a trach. We are appealing to you for advice for our mother who is over 90 and currently hospitalized with pneumonia. She was put on a respirator (intubated) 10 days ago. Her pulmonary doctor plans on putting in a trach. Today, they tested if she could breathe on her own and she couldn't. The pneumonia is still bad. How long can she remain on a respirator? We very badly want to avoid the trach.

(Asked by a family member)

Re: Intubation vs tracheostomy (elderly woman)

Posted: Mon Dec 07, 2015 1:46 am
by bachjr
If I were you, I would not consent to trach tube for her, even if she were 40, never mind 90. She does not need to be able to breathe to be extubated to full CNVS. Learn more at and review the references, and give copies to the docs, but they will probably resist reading them as being too much trouble to learn. If you refuse to consent to tracheotomy, they will have no choice. Insist that they do exactly as the papers describe.

To extubate her, she does not need to be strong enough to breathe, but the pneumonia must be clear and this can often only be accomplished by using MIE via the endotracheal tube as described. The docs will say that it is not good to be intubated a long time, but we have had patients intubated 6 months waiting to be transferred to us to be extubated.