Posted: Mon Dec 07, 2015 1:25 am
My relative has been intubated for three weeks and the doctors are saying that a tracheostomy tube is necessary to avoid damage to the trachea. What do I do?
(Asked by a family member)
Re: Prolonged intubation
Posted: Mon Dec 07, 2015 1:28 am
We have had patients intubated in hospitals for over 5 months who failed extubation up to 6 times before transfer and successful extubation in under 24 hours in our units. While it is true that prolonged intubation can damage the upper airway, so too can prolonged tracheostomies, and according to the medical literature, the greatest risk of damage is when intubated patients undergo tracheotomy. There is little doubt that it is safer to be intubated for one month or more if one can then be extubated to CNVS and MIE rather than undergo tracheotomy in the hope that the tube can eventually be removed. (See JBCVBook7 for morbidity and mortality caused by tracheostomy tubes.)
Despite what physicians tell intubated patients who resist tracheotomy, trach tubes hamper ventilator weaning rather than facilitate it (see Management of Patients with Neuromuscular Disease). A tracheostomy tube can cause loss of the ability to swallow and that ability can be lost for life even after the tube is removed. 4 out of 5 ALS patients with tracheostomy tubes die because of the tubes themselves (from infection and other complications). Thus, prolonged intubation to CNVS and MIE is generally preferable to intubation to tracheotomy.
Instead of consenting to trach tubes for failure to wean, give the physicians to inform them how to extubate without need to wean. Inform them that, if the problem is only respiratory muscle weakness without severe disease of other organs and if it is a matter of failure to wean from ventilatory support, there are peer-reviewed publications that will explain how to safely extubate. If local doctors do not follow the articles’ instructions, then request transfer to the closest "Center for Noninvasive Respiratory Management."