My Dad’s Ventilated with Tracheostomy,He Can’t Wean Because of Stroke&Parkinson’s Should He Go Home?

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My Dad’s Ventilated with Tracheostomy, He Can’t Wean Because Of Stroke & Parkinson’s, Should He Go Home?

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Hi, it’s Patrik Hutzel from intensivecareathome.com where we provide tailor-made solutions for long-term ventilated adults and children with tracheostomies and where we also provide tailor-made solutions for hospitals and intensive care units whilst providing quality care for long-term ventilated adults and children with tracheostomies, also otherwise medically complex adults and children at home, including Home BIPAP (bilevel positive airway pressure), Home CPAP (continuous positive airway pressure), home tracheostomy care when adults and children are not ventilated. We also provide Home TPN (total parenteral nutrition), Home IV potassium, Home IV magnesium infusions as well as IV antibiotics at home. We also provide port management, central line management, PICC (Peripherally Inserted Central Catheter) line management, Hickman’s line management, as well as palliative care services at home.

We have also provided an emergency department bypass service for the Western Sydney Local Area Health District because we have been sending our critical care nurses into the home to avoid emergency department admissions as well.

So, today I have a question from Jane that I want to answer, and Jane says,

“Hi, Patrik.

My dad is 66 years old. He’s has been in ICU for 14 days. Two days ago, they did a tracheostomy because he couldn’t breathe on his own. He’s still on the ventilator after the tracheostomy because he still can’t breathe on his own. The doctor said they will try and wean him off step by step, and it is really important if his heart and brain can endure this during this challenging time. He is having neurological problems. The brain is not giving signals to the respiratory system to breathe.

All his other organs seem to be OK. His vital signs seem to be stable as well. He does open his eyes. He sheds tears sometimes. He responds to stimuli, answers to the commands given by doctors and nurses but when told to breathe, he tries but gets tired immediately because his muscles are too weak.

He was also diagnosed late last year with Parkinson’s disease, diabetes, and he had some brain damage because of some brain strokes he had. The last three months, he was also losing weight because he couldn’t eat and had sleep deprivation during the night and slept a lot during the day.

Is there hope for him? How much can it take him to recover? What can we do for him? Can we take him home if he can’t be weaned off the ventilator in ICU?

From, Jane.”

Well, Jane, thank you so much for reaching out with your question.

It’s probably way too early to see where this is going, given that he’s only had a tracheostomy a couple of days ago but given that he had a stroke and he’s been diagnosed with Parkinson’s, weaning off the ventilator might be slow and challenging.

Also, if he couldn’t sleep at night but slept a lot during the day, I’m also wondering whether he might have sleep apnea, and whether he has a high CO2 or carbon dioxide is high because that might also mean he needs some form of ventilation going forward. Obviously, your question there to ask is, what is his CO2 like? And if he can’t come off the ventilator, they probably need to do a sleep study to work out what he needs going forward, whether he needs ventilation at all, assuming he can’t be weaned off the ventilator. You do mention that he’s too weak at the moment.

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