What should I expect if they have to do a trach on my husband?

[lostwithouthim]

My husband has been on a ventilator for 7 days due to Covid. He was able to reach a PEEP of 5 and FIO2 of 40% with his O2 saturation remaining in the 90's. The doctor said he is strong and his lungs even seem to be fairly strong. They started weaning him from the sedation (Fentanyl and Versed) two days ago. They said he is having a lot of agitation and they will try several different combinations of meds to get this under control so maybe they can still remove the vent but doesn't additional medication just start the sedation process over? He said if they are not able to control the agitation in the next couple of days they will have to do a trach. If that ends up happening I am worried because they have had him on such high doses of blood thinner so I would assume there has to be a risk of excess bleeding associated with the trach insertion. Also, if he does have to have this procedure, are they conscious afterword? Can they speak with the trach?

[Ferham]

Hello and welcome

This is such a distressing time for you . His Oxygen levels look strong . My husband took weeks to get the sedation hold lifted (His oxygen levels weren't as good as your husbands )

My Husband got very agitated and his BP went sky high.

The team that perform trachy's are so skilled and able. They will be monitoring every single thing on your husband when they do this, He will still be sedated, when he is off all sedation and starts to come round he initially won't be able to speak, until they place a speaking valve in.

It's a glorious moment the 1st time you hear their voice, when they come round.

[lostwithouthim in reply to Ferham]

Thank you for your response! This is a terribly hard time but it helps to read these stories and know I am not alone!

[Sepsur]

Welcome @lostwithouthim

In my case the trachy was a positive move forward to being woken up out of sedation.

I couldn’t speak at first with a trachy, I came round without understanding anything that had gone on, not speaking was another frustration, as was no one being able to lip read. Eventually they fitted a valve and they would ‘lower the cuff’ enabling me to speak for a very short time. My voice had no strength at first. Hoping you hear more promising news over the next few days

[Malletus]

Hi, sorry to read that your husband is having such a tough time right now.

My husband was in ICU on a ventilator with Covid. He had a trachy fitted after a couple of weeks. They were keen to do this so that when he woke up from sedation he would not have the ventilator tube in his mouth and throat - the trachey is much more comfortable for the patient when awake and also causes less trauma to the vocal chords. Also, a trachey will allow your husband to eat and swallow when he is allowed. At first the patient can’t speak with a trachy but when he’s well enough they have a speaking valve fitted and the Speech and Language team will show him how to speak with the valve as there is a special technique. My husband found this difficult at first but he did get used to it and found it easier as he got stronger. As others have said, tracheostomy is a common and routine procedure in ICU, usually done in theatre and your husband won’t feel it.

I was told having a trachy fitted was a positive step forward.

Also agitation is very common in ICU.

Hope that helps and best wishes to your husband. I know how worried you must be. Hang in there. Your husband sounds like a strong fighter!

[Jbujanda82]

My dad did really well after he had his tracheostomy done. He was able to get off the sedation and pain meds and was weaned off the ventilator. Once he was alert enough they put a cap on the tracheostomy and he was able to speak. We were also a little scared when the doctor started talking to us about the procedure but in the end I think it helped a lot.

[LeopardGecko]

Having a tracheostomy is definitely a step in the right direction. They are very experienced in the procedure and most of the time it can just be done there and then on the ward where the patient is.

Once my husband had his done, he came round quite quickly but it took a long time before he was able to use a speaking valve. It was a frustrating time when he couldn't speak but we used an alphabet chart to get the important words that we couldn't make out from lip reading which helped a little bit.

I hope your husband continues to improve - it will definitely be nice for you to see him awake and have some communication with him 😊

[FamilyHistorian]

Hi lostwithouthim

I'm not a medical person, I didn't have covid I'm 72 but I did have a trachy.

So most of this information has been gleaned from my wife. Long story short just before Christmas '19 I was admitted to the Birmingham QE and apart from pneumonia and possible sepsis I required my aortic artificial valve to be replaced. I was already sedated / ventilated in ICU and was operated on just before Christmas. I was not tolerating the ventilation tube very well and it was decide to give me a trachy. In the QE this is normally done in the patients bed. However because there is an element of risk there must be the availability of theatre. Because it was Christmas they couldn't guarantee a theatre team quick enough should it be needed. Therefore my trachy was fitted after Christmas whilst I was in bed and theatre wasn't needed.

I am on thinners including the jabs to to the stomach. There was a slight hitch in that one of my vocal chord nerves (I think thats right) was damaged. So the intubation tube was removed. I was sedated for nearly 2 months. So when I came round the trachy didn't cause me any problems. Even when I was agitated I went for the other tubes which I was able to pull out until they put boxing type gloves on me - spoil sports.

Once I came round I wasn't able to speak until they attached a voice box to the trachy which I adapted to straight away and in fact we tried several different voices including an american cowboy accent. The down side was that I was only allowed to use this voice box for short periods of time which was very frustrating especially people heard that I had a voice and came to speak to me only to find the the bloddy thing had been taken away!

There are plenty of tails about what happens to patients in ICU but keeping on the trachy theme the weight loss includes muscle loss which also effects the voice box so I had to do exercises with ice chips to retrain my voice. Eventually the trachy was removed and the wound allowed to heal. When you start to speak "normally" you have to hold the dressing on your neck to make sure that the wound is airtight. I could never find where to put my finger so that stuck and ecg nipple on the dressing so I would lnow exactly where to press. So my voice is back, my wife says its virtually normal (but that doesn't really matter so long as you can speak) however I did have a distinctive laugh, thats gone, but I can laugh.

Having a trachy is the least of his problems

😂