My 87 year old grandmother was intubated due to septic shock 11 days ago. She has since regained consciousness, is able to write, is off vasopressors for low BP, and they think the infection is almost gone. She wrote she wanted a tracheostomy so she can communicate better and be transferred to a rehab for ventilator dependent patients. They say they don’t want to do this now and are pushing to extubate and let nature take its course. However, I can’t seem to understand why a tracheostomy is so much more dangerous than that. Are there risks or contraindications that I’m missing here? Does the procedure have a high mortality rate (I’m talking while on the table)?
"she can learn to speak with a valve then she is off of the ventilator. Plus she can practice swallowing" Is she going to be able to learn to do this?
For now, I would go with the Doctor's.
Second, Chapdelaine, I’d suggest whomever is your Grans MedicalDPOA clearly speak with her care team as to what may have happened as an effect of her sepsis. Septic shock / sepsis is a very big deal for anyone who goes thru this but especially for elderly patients. My MIL - had been in a SNF then got very ill and hospitalized- had this and although she was able to get various antibiotics to quell the infections, the sepsis affected her organs. It was described to us as she was undergoing “cascading organ failure” with some days pretty ok and others not so. And it all would eventually becomes MODS / Multiple Organ Dysfunction Syndrome. Mil was discharged from hospital to an in-unit hospice that was in its own building separate but adjacent to the hospital. It was a Medicare covered benefit. The reason not to trach/vent was that MODS was happening and would not increase her quality of life or lifespan. It wasn’t that she couldn’t successfully go thru the procedureS but it was more than the procedures would be of no real benefit. It was letting nature take its course; she was made comfortable with medications and high flow O2. The impression I got was that once MODS is happening for someone elderly, they are not expected to live very long. So for MIL, hospice was the next step for her care plan. For us, mil was on pretty serious black box drugs - fenantyl lilipops among other meds - and had had highly contagious infections so being in an in-unit hospice was the best place for her as those places have the medications and staff trained for delivering them; the discharge planner at the hospital took care of all this. It was pretty seamless transfer.
If hospice has not been brought up an an option for your grandmother, please ask about if it’s (hospice) an option to consider.