Child Extubation Essay

There are numerous other techniques used to prevent VAP. Like many respiratory problems the head of the bed should always be elevated to between 30 and 45 degrees to prevent aspiration of fluids and sputum. The tubing for the ventilator should only be changed on a as needed basis. The continuous changing of tubes moves the bacteria and can introduce new bacteria into the respiratory system. Patients should also receive “sedation vacations” and prophylaxis medications to prevent peptic ulcers. Weaning of the mechanical ventilator should also be done as soon as possible

In the article, unplanned extubation (UE) is shown to be one of the complications that occur frequently with mechanical ventilation in neonates in the neonatal intensive care unit. This warranties the trial of other techniques such as Noninvasive ventilation (NIV). According to the author, this technique is only adequate for neonates that display adequate respiratory effort. In the article, a study was carried out to determine the effectiveness of NIV in providing ventilatory support in neonates with unplanned extubation as a result of the use of conventional ventilatory techniques. The study extended to establish instances that NIV failed to restore the condition in neonates.

Post-transplant, patients are monitored very closely in the intensive care unit (ICU) and pharmacological and mechanical management is implemented when necessary. Within the first 24-48 hours after surgery, a patient is ventilated and their Po2 and Pco2 levels are scrutinized. Diuretics may be used in order to avoid any complications from fluid buildup or imbalances that may occur and help with pulmonary recovery.2 Other complications that may occur within the first two days of surgery include: technical complications, graft dysfunction, infections, and rejection. Stenosis of one or more of the anastomoses accounts for 15% the technical complications, which may lead to graft dysfunction.4 Other components of graft dysfunction incorporate pathology from

Insufficient respiratory drive is common for post anesthesia patients. Patients are often given narcotics for pain which is a central nervous system depressant. The patient’s tongue may also fall to the back of their throat. There is also a risk for aspiration as secretions or vomit may be present in the airway and the patient will likely have a weak cough following sedation and intubation. The third major risk of respiratory compromise is atelectasis. This is caused by alveolar collapse. The alveoli are held open by surfactant and pressure in the form

Lung protective ventilation strategies are interventions to decrease potentials of lung injuries that could be acquired from the ventilator. The ventilator setting should be checked once an hour to make sure the patient is still on the correct mode and the correct settings selected; frequent checks will minimize any errors and way of assessing the patient’s tolerance to the current settings. Maintaining a low tidal volume is one strategy to reduce barotrauma. The ideal tidal volume should be 6ml/kg; Mary’s current weight is 81 kg thus the ideal tidal volume is 486 or lower and she is currently on 450 which is good. A second intervention to minimize lung injury is decreasing FiO2, the current ventilator setting is FiO2 1.0 which can cause

When T-tube and CPAP were compared in the Study (108), it showed that use of T-tube did not impair arterial oxygenation. Further it showed that extubation with T-tube could be superior to CPAP when the pattern of change in PaO2/FiO2 was taken into consideration to predict extubation outcome. The PaO2/FiO2 showed an initial decline and then increasing trend in case of T-tube whereas it had a declining trend in CPAP group. Study by Cekmen N et al. had contrary result showing the number of unsuccessful weaning being higher in T-tube group as compared to CPAP group. However the hemodynamic parameters and arterial blood gases analysis was comparable within and in between CPAP and T-tube group (113).

Liver transplantation (LT) is a well-established curative therapy for irreversible chronic end-stage liver disease or acute liver failure. Since the introduction of the liver transplant procedure, it has been a standard approach to give postoperative ventilation in children and exact timing of extubation is usually debatable, but it has been noted that early or even immediate extubation may be a feasible approach nowadays (1-3). It is important to assess the timing of extubation because premature discontinuation can be associated with respiratory complications such as airway obstruction, aspiration of tracheal secretions leading to pneumonia (4) and prolonged ventilation can lead to complications like endobronchial intubation, post-intubation stridor, endotracheal tube blockage, pulmonary air leak, bronchopulmonary dysplasia, pulmonary atelectasis (5). Therefore, identifying variables that can predict readiness for extubation will help us decrease morbidity and complications related to mechanical ventilation and also provide safe and quality care for this patient population. This study focuses on identification of the risk factors for delayed extubation and it is anticipated that variables such as age, preoperative weight, preoperative hemoglobin, the volume of blood products transfused and pH after induction can cause delayed

Intubation and mechanical ventilation is a common life-saving intervention that is used in the hospital when the patient does not have adequate oxygenation or airway. It can be used to replace or assist a patient’s spontaneous breathing. In order to manage the ventilation settings you have to set the time, volume, flow and airway pressure. If the wrong settings are used it can cause ventilator-induced lung injury due to the over-distention of the lungs. The patient can be extubated when the physician determines that the problem has been solved and that the patient has adequate oxygenation and ventilation.

Cardiac surgeries are considered as major surgeries with the intensive care needs during the immediate postoperative period. Post-operative cardiac patients are generally admitted to the intensive care unit (ICU), which is considered as one of the fundamental reasons to implement the mechanical ventilation (MV). Whether is indicated when the patient's spontaneous ventilation is inadequate to sustain life by provide adequate oxygenation. They stay on MV until consciousness is reestablished. However, in some cases they prone to require a longer period of respiratory support [1,2,3]. Although other studies define the prolonged mechanical ventilation (PMV) by used several durations. For our study we adopted to define PMV as cumulative duration

To transplant a life-sustaining organ into a patient that has already been deemed non-adherent with their previous transplant would essentially be wasting that organ. In a study conducted by the Department of Surgery at the University of Minnesota, of 3,408 primary transplant

Background: Airway assessment is one of the most predictable ways to identify the difficulties of the airway, especially if the patient has to do a surgery and have to be intubated. We can predict by airway examination the difficulties of the patient’s airway track, and put many plans regarding how to do intubation safely. The target of patient’s airway assessment is to detect any existing deformities in the airway and face in order to make a suitable plan to secure the airway successfully. Between June 2002 and September 2003, an observational study conducted in the emergency department of UK teaching hospital, 156 patients who involved in the study and undertook airway assessment based on L-E-M-O-N method were all intubated successfully. The study concluded that “Use of this score would encourage airway managers to conduct a thorough systematic evaluation of the airway and to readily anticipate problems in its management.

Mechanically ventilated patients are increasingly at the risk of acquiring Ventilator-associated pneumonia (VAP) which is the leading infectious complication, affecting from 8% to 28% of patients admitted in the intensive care units. Morbidity and mortality associated with the development of VAP is high, with mortality rates ranging from 20 to 41%.Development of VAP increases ventilator days, critical care and hospital lengths of stay. Essential airway management is one of the important interventions to prevent ventilator associated pneumonia. Manual Hyperinflation (MH) enhances clearance of airway secretions and thereby improved lung compliance, reduced inspiratory resistance, improved V/Q matching, cleared airway and re-expanding the collapsed alveoli. MH could resemble a forceful cough, with which, sputum could propagate from distal to more proximal areas that is, from the smaller airways toward the larger airways, where it can be easily removed through endotracheal suctioning. Hence MH followed by suctioning is considered to be a suitable intervention to prevent VAP among intubated and mechanically ventilated patients.

There comes a point when a critically ill patient can no longer maintain the basic oxygenation and the removal of carbon dioxide of their blood and tissues. When that point is reached the job can be performed for the patient through the use if Extracorporeal Membrane Oxygenation. This treatment was developed in the 1970’s and used primarily in children due to the high rate of complications see in adults (Kulkarni, Tejaswini & Sharma, Nirmal & Diaz-Guzman, Enrique, 2016, p. 373). The following will discuss what ECMO is, indications for the use of ECMO, and the potential complications inherent in the use of ECMO.

Vascularization is done either through a shared blood supply from adjacent structure or angiogenesis within the graft. Angiogenesis was confirmed in all patients by one-month. The patient with postmortem analysis showed the presence of capillary proliferation, whereas in the other patient bleeding was elicited by bronchoscope contact of the graft within the lumen. These results show that the grafts will likely not failure due to inadequate vascularization. Despite these promising results the patients experienced stenosis and fungal infections that complicated their post-operative periods. Stenosis was identified in two patients along the distal anastomosis sites secondary to scar formation. In both cases the stenosis responded well to serial balloon dilation. Fungal infections were found in two patients, although one was likely caused by the pre- and postoperative steroid administration. Based on this it is suggested that patients with TET transplantation should be treated with prophylactic with anti-fungal

Hofer et al. (2005) presented a case study of a 42 year old male who is morbidly obese (433kg) presenting for bariatric surgery. His comorbidities included obstructive sleep apnea, pulmonary hypertension, lower extremity lymphedema, and gastroesophageal reflux. Arterial blood gas was obtained and the results were as follows: pH 7.39, PaO2 69 mmHg, SaO2 91%, bicarbonate 30mEq, and PaCO2 51 mmHg and a pulmonary function test that indicated severe restrictive pattern. The patient’s intra-operative pain was strictly treated with dexmedetomidine. Post-operatively the patient was transferred to the ICU and remained intubated overnight due to not meeting extubation criteria, which he did meet two hours later, but the decision was made to leave the patient intubated overnight. Once extubated, the patient’s opioid requirements were less; indicating that opioid-free anesthesia is an effective alternative pain relief while avoiding opioid-induced respiratory depression.