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Managing the Artificial Airway

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Managing the Artificial Airway RC 275 Tracheotomy/Tracheostomy When intubation can t be done or the need for the airway is indefinitely long Traditional surgical ... – PowerPoint PPT presentation

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Title: Managing the Artificial Airway


1
Managing the Artificial Airway
  • RC 275

2
Tracheotomy/Tracheostomy
  • When intubation cant be done or the need for the
    airway is indefinitely long
  • Traditional surgical incision or PDT
    (Percutaneous Dilatational Tracheotomy)
  • PDT may not be as damaging to tracheal cartilage

3
RCPs Role During the Procedure
  • Monitor the patient!
  • Maintain adequate ventilation and oxygenation
  • Assist physician as needed

4
Try to leave the fresh trach undisturbed for 48
hours
  • Suctioning obviously must be performed but as
    gently as possible

5
Complications Associated with ET and Trach Tubes
  • Can be due to the insertion procedure or from
    having the tube in the airway

6
Intubation Complications
  • Trauma to oral cavity, pharynx, and vocal cords
  • Bleeding
  • Laryngospasm
  • Sub-Q Emphysema (from perforation of trachea)
  • Improper tube placement
  • Contamination/Infection

7
Tracheotomy Complications
  • Bleeding (can be life-threatening)
  • Pneumothorax
  • Sub-Q Emphysema
  • Contamination/Infection

8
Complications due to irritation from the tube and
cuff
  • Contamination/Infection
  • Obstructed Tube
  • Tracheitis (sore throat)
  • Glottic and/or sub-glottic edema (may not
    manifest until tube is removed)
  • Vocal cord damage (ET tubes only)
  • Paralysis, polyps, granuloma formation

9
Complications Due to High Cuff Pressures
  • Normal Mean Hemodynamics in the Tracheal Mucosa
  • Lymphatic 5mmhg
  • Venous 18 mmhg
  • Arterial 30 mmhg
  • Impeding/occluding arterial flow causes ischemia!
  • Impeding/occluding lymphatic or venous flow
    causes edema

10
Effects of Excessive Cuff Pressure
  • Ischemia
  • Inflammation
  • Necrosis
  • Fibrosis
  • Stenosis
  • Tracheal Malacia
  • T-E Fistula

11
Cuff Pressure Should NOT Exceed 25-30 cmH2O!
  • The pressure in the cuff should be checked often,
    eg each ventilator check

12
Cuff Inflation Management Techniques
  • MOV Minimal Occlusive Volume
  • MLT- Minimal Leak Technique

13
MOV- Minimal Occlusive Volume
  • Air is slowly added to cuff until either pressure
    cycling occurs (if applicable) or exhaled volume
    equals inhaled tidal volume
  • Cuff pressure is then checked to make sure it
    does not exceed 25-30 cmH20 and adjusted to still
    allow pressure cycling or returned exhaled volume

14
Minimal Leak Technique
  • Like MOV except after cycling or volume return is
    achieved, a slight amount of air is removed to
    cause either
  • (1) a loss of no more than 50 ml of set Vt
  • (2) An audible leak heard around trachea

15
Again, these techniques should be utilized each
time the cuff is checked
  • If high pressures are needed initially, the
    artificial airway is probably too small
  • If cuff pressures gradually increase, damage to
    the trachea may be occurring

16
Extubation
  • Done when none of the four indications for an
    artificial airway exist

17
Extubation Technique
  • Have suction, BVM and O2, and intubation supplies
    ready(including tracheotomy tray)
  • In Fowlers or semi-Fowlers, suction through
    tube and pharynx
  • Loosen tape and deflate cuff
  • Insert new suction catheter into tube and have
    patient take a deep breath
  • Apply suction as tube is pulled out and have
    patient cough at the same time
  • Monitor vitals and respiratory status

18
Possible Complications
  • Inspiratory stridor due to glottic or sub-glottic
    edema
  • Stridor that develops immediately after
    extubation is an ominous sign
  • Laryngospasm/Bronchospasm
  • Dyspnea

19
Post-Extubation Treatment
  • O2 Therapy
  • For stridor, nebulized racemic epinephrine and a
    steroid
  • If distress is not helped by nebulized drugs,
    re-intubate
  • If not possible, tracheotomy

20
Time to face the music!
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