Double Lumen Tube Essay

It has been repeatedly stated that oral care is important in the prevention of ventilator-associated pneumonia (VAP). Endotracheal intubation predisposes patients to developing VAP. The tube acts as a conduit from the mouth to the lungs – a perfect track for bacteria to descend upon. Khezeri, et al. (2014) suggest that “the presence of an endotracheal tube (ETT) inhibits normal coughing, normal swallowing, and the protection of the trachea contact by epiglottis closure.” In addition, an endotracheal tube keeps the patients mouth open – leading to dryness. Bacteria are not washed away by saliva. Also, Landgraf, et al. (2017) mention that the presence of an endotracheal tube in the mouth causes “changes in the oral epithelium” which “might indicate risk for infection in intensive care patients

ICU patients suffer from a broad range of pathologies, requiring MV, sedation and use of multiples devices, which do not allow patients to protect their airway (Augustyn. 2007; Kollef. 2004).

Another important intervention was to maintain the head of the bed at 30-45 degrees and position L.M.’s left lung into a dependent position to improve ventilation and perfusion. L.M.’s O2 was decreased to 63 and her CO2 was increased to 50. According to the IHI, it is recommended to elevate the bed to 30- 45 degrees to improve ventilation. Patients that lay in the supine position have lower spontaneous tidal volumes on pressure support ventilation compared to those laying at more of an angle (Institute for Healthcare Improvement, 2012). In regards to positioning, when the least damaged portion of the lung is placed in a dependent position it receives preferential blood flow. This redistribution of blood flow helps match ventilation and perfusion, therefore, improving gas exchange (Lough, Stacy & Urden, 2010). Implementing these interventions combined with respiratory therapy, significantly improved the blood gas values for oxygen and carbon dioxide levels.

When the organs fail the only option is a transplant. With lungs there is only a 50% rate of a five year survival rate after a lung transplantation involving the end-stage respiratory disease. With such a drastic survival rate a study was completed to determine if patients could have a better outcome. This study was done to help determine effective methods to enhance lung transplants before surgery; the Doctors placed the recipients on bi-level positive airway pressure ventilation (BIPAP.) “BIPAP is a noninvasive mode of ventilation administered through a tight-fitting mask to assist spontaneously breathing patients”

Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is

Although different kinds of tubes are placed in a patient at the bedside every day, it is important to remember the complications that can arise if a tube in not placed correctly or in the right place. Health care workers recognize this risk and take steps to ensure proper insertion. This study recommends that health care workers use at least two bedside methods to verify placement. These include, pH, visual signs of aspirate, patient’s respiratory condition, monitoring the tube every four hours, marking the exit location of the tube and capnography. These methods have all been backed by research to show their validity in determining tube placement. Although included on the list, the auscultation of an air bolus is not included in one of the recommended bedside tests. Although it is widely used in practice, the article states that “no evidence indicates that the auscultatory method is useful for determining the location” ( Methany 2016). If heath care providers relied on the auscultation method as one of the recommended bedside tests, the tube could be in the wrong place in the body or in the lungs. If feedings or medications were given through the tube in the wrong place it could lead to extreme complications or even death. This article notes x ray as, again, the gold standard for ensuring placement. This article along with several

Chest tubes are used to drain fluid or remove air from the patient’s chest area. My patient had a chest tube to drain his pleural effusion 26mL

There is a considerable controversy regarding the use of OBL in patients with respiratory failure and those on mechanical ventilation because of the potential high morbidity and mortality associated with its use in those patients (20, 21). While the role of OLB has become well established in the diagnosis of interstitial lung disease (18), its utility and safety are more controversial in critically ill patients. Proponents of OLB argue that solid diagnosis of underlying aetiology can be helpful in determination of the best course of treatment (22). Moreover, the risk of biopsy is fairly low if adequate precautions are taken (23). In contrast, opponents of OLB believe that defining the underlying mechanism of injury is largely academic and it will not add new to the treatment of those patients because of the lack of specific therapies for underlying aetiologies of ARDS and respiratory

Respiratory therapy refers to both a subject area within clinical medicine and to a distinct health care profession. During the 20th century, there were many health care fundamental transformations. Here are 10 possible predictions of what may occur in the future of respiratory care: (1) Less focus on raising PaO2 as a primary goal in managing patients with acute hypoxemic respiratory failure. (2) More attention to

From investigation in health practices, ventilator associated pneumonia caught my attention. “Ventilator Associated Pneumonia (VAP) is a leading cause of morbidity and mortality in intensive care units. Most episodes of VAP are thought to develop from the aspiration of oropharyngeal secretions containing potentially pathogenic organisms. Aspiration of gastric secretions may also contribute, though likely a lesser degree. Tracheal intubation interrupts the body’s anatomic and physiologic defenses against aspiration, making mechanical ventilation a major risk for Ventilator Associated Pneumonia. Semi-recumbent positioning of mechanically ventilated patients may help reduce the incidence of gastroesophageal reflux and lead to a decreased incidence of VAP. The one randomized trial to date of semi- recumbent positioning shows it to be an effective method of reducing VAP. Immobility in critically ill patients leads to atelectasis and decreased clearance of bronchopulmonary secretions. The accumulation of contaminated oropharyngeal secretions above the endotracheal tube cuff may contribute to the risk of aspiration. Removing these

The results for simulated airway restriction are shown at figure and table 3. Airway restriction prevents air from diffusing into pulmonary arteries as a kind of blockage in the lungs. Based on the data, peak inspiratory flow, peak expiratory flow, forced vital capacity, forced expired volume in one second, and the ratio FEV1/FVC are affected by the simulated restricted airflow. Peak respiratory flow, peak expiratory flow, and forced expired volume in one second have lower values in the restricted airway. The forced vital capacity is higher in the restricted airway simulation. The ratio FEV1/FVC which is 76% in an unrestricted airway dropped to 30% in the restricted airway simulation. This means that restricted airway is often accompanied by

The tracheostomy is a common surgical procedure which is performed in the Intensive Care Unit (ICU), as opposed to the operating room (OR). The patient is given general anesthia, a 2-3 cm incision is make from the second tracheal ring down divide the thyroid isthmus if needed. A hole is made between the third and fourth tracheal rings where a tracheostomy tube which are given by their inner and outer diameter, curvature and length to fit the patients’ trachea is inserted. A chest x-ray may be taken to check that the tube is correctly in place and there are no complications. The patient is often placed on a ventilator (breathing machine) to assist with breathing.

There will be a change in pulmonary function following the operation and anaesthesia including decrease in vital capacity and/or functional residual capacity and excess fluid in lung, which known as pulmonary oedema. The patient with advanced age is especially vulnerable for postoperative

Thirty patients underwent anesthesia for DO device procedures, 17 male and 13 female patients, no dropouts, age ranged between 8 and 17 years (Table 2). Inhalational induction was performed on 16 patients and awake fiberoptic bronchoscope with sedation was performed on 14 patients. Mouth opening improved significantly (p 0.001*) and Cormack and Lehane score improved significantly (p 0.021*) between the initial presentation for placement of MDO devices and on removal of the destructor under GA(Table 3). There were no instances of either difficult bag mask ventilation or airway obstruction on induction. There were no instances of failed intubation, no patient required emergency tracheostomy and no case resulted in death. At removal of MDO,

Tracheostomys may be required for long term control of excessive bronchial secretions, particularly in those with reduced consciousness or to maintain an