Extubational Difficulty

– Mechanical ventilation and positive end-expiratory pressure (PEEP) may compromise cardiac output and require modification of ventilator therapy (i.e., minimization of PEEP)

This study focuses on methods to confirm proper tube placement. Through a cross sectional study, the research concluded that over seventy eight percent of critical care health workers use multiple methods to confirm tube placement. Some of the more common methods include looking at the gastric aspirate’s pH, observing the patient for signs or respiratory distress, and capnography. Auscultation of the air bolus was not included in the study because it was deemed “unreliable”. However, a small separate study was done and about eighty eight percent of critical care health workers claimed they also used an air bolus auscultation as a method of confirming placement. So, what is the reasoning for health care workers to continue doing this if it is unreliable? It has been hypothesized that this method requires the least amount of supplies and the nurses can do it quickly and easily. This research study along with many others concludes that air bolus auscultation is not an accurate method because the sounds nurses are used to hearing that “confirm” proper tube placement in the gastrointestinal tract are the same as sounds heard in the lungs and other areas of the

On arrival to UKMC the patient received a Glasgow Coma Score of 3, which is an indication that intubation is needed. Bipap therapy was attempted but failed, due to respiratory failure. This was confirmed by arterial blood gases. After being assessed by the team at UKMC, the patient was intubated for respiratory failure, as well as shock of an unclear etiology. Rapid sequence intubation drugs, Etomidate and Succinylcholine where administered prior to intubation. A 7.5 endotracheal tube was used

Throughout my clinical rotation, the only concern for this patient was pain management and discomfort from the chest tube site. The patient was given Ketorolac for a pain of 4/10 using the numeric pain sale. The patient was also at risk for pneumonia and pressure ulcers from immobility and not coughing/deep breathing. Nursing interventions were getting the patient up to the chair and using the incentive spirometer ten-times per hour. Another concern was SOB and fatigue with activities.

Even though the consequence of saline instillation on a ventilator patient in the acute care setting is pneumonia or the patient may become hemodynamically unstable, this practice remain contentious, the practice of this procedure will also decrease the oxygenation. (Ayhan, et al., 2015),

Dimich-Ward, Helen, PhD; Michelle Lee Wymer, BSc; and Moira Chan-Yeung, MB. “Respiratory Health Survey of Respiratory Therapists” CHEST; Oct2004, Vol. 126 Issue 4, p1048-1053,

Patient outcome consisted of performing 10 deep breaths per hour. We have reviewed details that were difficult for the patient to remember, such as breathing out before placing the lips on the mouthpiece, and holding breath for 3 to 5 seconds at the top of each inhalation. With empathy, I provided understanding that being hospitalized is never easy due to sensory overload, pain and lack of privacy. Additionally, we have discussed the basic pathophysiology of lung inflammation and what it can do to a person. So overall, the outcome included enhanced disease knowledge with effective use of incentive spirometer.

The primary nursing diagnosis for this patient is impaired gas exchange, related to abnormal ventilation and perfusion ratio, as evidenced by restlessness, irritability, anxiety, decreased level of consciousness, abnormal arterial blood gases, and abnormal skin color (Gulanick & Myers, 2014, p. 82). A.C. has an endotracheal tube (ETT), and there is a note for the next day to have surgery to put in a tracheostomy. She is currently a smoker, her C02 is 74.6mEq/L which is high, her pH is low at 7.19, and the bicarbonate is 28.6mEq/L which is high. Her oxygen saturation is maintaining at 90%. Her PA02 is 56mm Hg and FI02 is 0.60. The patient is very anxious and restless in the bed, despite sedation and pain medication, and her skin is pale in color and she is diaphoretic.

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

An unplanned extubation (UE) in the Neonatal Intensive Care Unit (NICU) is an unforeseen occurrence observed due to various factors. One of these is due to the lack of a procedural standardization among healthcare providers. This is notably evident when staff is handling the infant during daily assessments and when care is rendered. The reason this issue was selected was because of the potential serious complications or death that a can occur to a patient due to the lack of procedural standardization, preventing UE is the issue that will be addressed.

In this study, patients that had been ventilated in the intensive care unit from April to November of 2010 were included. There were few ways that the person could be excluded, these were if the patient had cardiac arrhythmias or severe obesity. All of the patients were monitored vary closely, such as with an electrocardiogram, invasive and non-invasive arterial pressure, and percutaneous

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

One of the many benefits is monitoring the effectiveness of CPR that is favored among paramedics, continuous monitoring in Emergency Rooms and ICU during ambulatory transport for confirmation of accurate placement of ETT (endotracheal tube). It offers a rapid alarm for ventilator disconnection which is identified by a flat line on the capnogram. It also provides an early warning signs of shock, displaying a decreased numeric value in ETCO2. This has implications with any patient that is at risk for shock, especially trauma and cardiac patients. Patients who are suffering from hyperthermia when their metabolism is suppressed and their internal temperature is on critical overdrive--increasing their ETCO2 levels significantly. ETCO2 is also used among asthmatic patients and those with anxiety disorders by teaching them how to effectively control their breathing. Furthermore, it has been verified that in postoperative patients especially “high risk”-those with obstructive sleep apnea and those receiving high doses of opioids for pain management are more of an increased risk of adverse respiratory events and through proper patient monitoring through use of ETCO2 can prevents such undesired events. “Capnography can serve as a rapid assessment and triage tool for critically injured patients and victims of chemical exposure. It provides the ABCs in less than 15 seconds.”-Krauss, Heightman, JEMS,

Background and Rationale: Currently, postoperative pulmonary complications “account for about 25% of deaths occurring within 6 days of surgery,” (Yoder, M 2015). Post-operative pulmonary complications (PPCs) are of major concern due to the increased length of hospital stays and high rates of occurrence and death as a result. Those at greater risk of developing a pulmonary complication include preexisting lung disease, medical comorbidities, poor nutritional status, overall poor health, and in those who smoke. (Yoder, M, 2015.) The type of surgery the patient is having also affects the risk. Complications include, but are not limited to, pneumonia, bronchospasm, respiratory failure and prolonged mechanical ventilation. The development of such complications negatively affects the expected outcomes for patients. “The basic mechanism of PPCs is a lack of lung inflation that occurs because of a change in breathing to a shallow, monotonous breathing pattern without periodic sighs, prolonged recumbent positioning and temporary diaphragmatic dysfunction. Mucociliary clearance along with the decreased cough effectiveness, increases risks associated with retained pulmonary secretions, “ (Overend, T., Anderson, C., Lucy, S., Bhatia, C., Jonsson, B., & Timmermans, C., 2001). Currently,

T-piece test results may be too conservative if the clinicians are very cautious and/or if the prevalence of extubation failure is low (e.g., in postoperative patients). On the other hand, the low-PS test may underestimate the risk of extubation failure, especially if the clinician is overop- timistic or if the prevalence of extubation failure is high (e.g., in patients under prolonged mechanical ventilation or having ICU- acquired polyneuromyopathy). Keeping PEEP during the test may increase the rate of extubation failure due to lung or heart