Tracheostomy: Care Options and Quality of Life for Patients

Q: Tracheostomy: Care Options and Quality of Life for Patients

Xiao Zhen： Hello, I will answer your questions briefly as follows： 1. <br>Performing a tracheostomy allows for better airway management, making the patient more comfortable. <br>As long as they can be weaned off the ventilator, there is a possibility of extubation in the future.

Regarding tracheostomy?

Dear Dr.
Yang,
I apologize for bothering you again.
My father has been in the respiratory intensive care unit for over ten days, and he has been on a ventilator for more than ten days prior to that.
Recently, the medical staff has been continuously providing respiratory therapy for him, but there has been no improvement.
After discussions among the doctors, they have decided to proceed with a tracheostomy.
The doctors informed me that it is impossible for my father to be weaned off the ventilator.
I would like to ask if my father will still need to remain in the intensive care unit after the tracheostomy.
Additionally, since my father is insisting on being discharged, if he cannot receive home care after the procedure, will he need to be transferred to a nursing facility or continue to stay in the hospital?
Furthermore, I would like to inquire if terminal cancer patients can experience generalized edema.
My father's condition has resulted in significant swelling, even in his testicles, which is quite alarming.
The doctor previously administered diuretics, but there has been no improvement.
We all understand that my father cannot be cured and that his time is limited.
However, what we hope for now is to ensure that he receives the best possible care and quality of life during the time he can spend with us.
Thank you again for your response, and I apologize for the disturbance.

Xiao Zhen, 20~29 year old female. Ask Date: 2004/08/03

Dr. Yang Wenda reply Pulmonology

Xiao Zhen: Hello, I will answer your questions briefly as follows: 1.
Performing a tracheostomy allows for better airway management, making the patient more comfortable.
As long as they can be weaned off the ventilator, there is a possibility of extubation in the future.
2.
As long as blood pressure, heart rate, and other indicators remain stable, the patient can be transferred to a chronic respiratory care unit (there are many such units both in and out of the hospital).
Home care can be challenging.
3.
Terminal cancer patients may experience nutritional deficiencies and generalized edema due to prolonged bed rest, and relying solely on diuretics may have limited effectiveness; it is advisable to discuss with the physician if there are other options available.
4.
Terminal cancer patients are less lonely when they have family members accompanying them.
Consider transferring to a chronic respiratory care unit, where there are no visiting hour restrictions for family members, making caregiving more convenient.
I hope they have your companionship in their final journey.

Reply Date: 2004/08/03

More Info

Dear [Name],
Thank you for reaching out with your concerns regarding your father's condition and the potential tracheostomy procedure. It is understandable to feel overwhelmed during such a challenging time, and I appreciate your desire to ensure the best possible care for your father.

A tracheostomy is a surgical procedure that involves creating an opening in the neck to place a tube into the windpipe (trachea). This procedure is often performed when patients require long-term ventilation support or have difficulty breathing due to various medical conditions. In your father's case, it seems that the decision to proceed with a tracheostomy was made after careful consideration of his ongoing respiratory challenges and the lack of improvement with traditional ventilation methods.

Post-Tracheostomy Care and Hospitalization:
After a tracheostomy, the length of time your father will need to stay in the intensive care unit (ICU) or hospital depends on several factors, including his overall health, the reason for the tracheostomy, and how well he adjusts to the new breathing method. In many cases, patients may remain in the ICU for a few days to ensure that they are stable and that the tracheostomy site is healing properly. Once he is stable, he may be transferred to a step-down unit or a general medical floor for further monitoring and care.

If your father is unable to be cared for at home after the procedure, options include transferring him to a rehabilitation facility or a long-term care facility that specializes in respiratory care. These facilities are equipped to provide the necessary support for patients with tracheostomies and can help manage any complications that may arise.

Quality of Life Considerations:
It is essential to discuss with the healthcare team the goals of care for your father. If the focus is on comfort and quality of life, palliative care services can be integrated into his treatment plan. Palliative care specialists can help manage symptoms, including pain and discomfort, and provide emotional support for both your father and your family.

Regarding your question about edema (swelling) in cancer patients, it is not uncommon for individuals with advanced cancer to experience fluid retention, which can lead to swelling in various parts of the body, including the extremities and even the genital area. This condition can be exacerbated by factors such as kidney function, medications (like diuretics), and the overall state of health. If diuretics have not been effective, it may be worth discussing alternative management strategies with his healthcare team.

Final Thoughts:
It is commendable that you are advocating for your father's comfort and quality of life during this difficult time. Open communication with his medical team is crucial; they can provide guidance on the best care options available and help you navigate the complexities of his condition. Additionally, consider seeking support from palliative care services, which can enhance your father's quality of life and provide much-needed support for your family.

Please remember that you are not alone in this journey, and there are resources available to help you and your father through this challenging time. If you have further questions or need assistance, do not hesitate to reach out.

Best wishes for you and your family during this time.

Sincerely,
Doctor Q&A Teams

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