Tracheostomy Essay

INDICATIONS FOR SURGERY: The patient is a 62-year-old Caucasian male who has pneumonia. The patient has been on a ventilator for over 2 weeks and appears to require long-term ventilator. The patient is undergoing tracheostomy for this purpose.

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”

70% of her right lung is collapsed and is not taking part in gas exchange

Due to the mechanical ventilator, it is able to assist in oxygen perfusion to all of her tissue. Thus, the lungs will be able to expand appropriately.

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

A.W.’s chest tube is inserted successfully and she is stabilized. She is admitted to the ICU and will be in the hospital on bed rest for a minimum of several days as she recovers.

The patient may have a hard time breathing because she is in pain after having surgery. Since they patient doesn’t want to breath due to the pain it can cause atelectasis and later sepsis if not treated in time. It would be important to teach the patient about splinting and to use an incentive spirometry in order to help her be able to breath. Another risk factor for the patient not being able to oxygenate would be hypovolemia since there is less blood volume which can also lead to less oxygen being able to travel in the blood or able to perfuse throughout the body.

Per the study, the “findings have a few important implications. A substantial minority of patients aged 80 and older who have major noncardiac surgery die or suffer a postoperative complication, but the majority have good outcomes, and for many operations, mortality rates were low (>2%).” The

82 developed an index defined as GAP (gender, age, physiology), in order to predict mortality in IPF. US and Italian patients included in this study were divided in three groups: 228 patients, 44.3% of which with biopsy proven IPF, were included in the derivation cohort and 555, 54.7% of which with biopsy, in two validation cohorts of 330 and 325 patients. Mean follow-up was 1.7 and 2.4 in the derivation and the validation cohorts, respectively. The primary endpoint of the study was time to death or lung transplantation. Overall mortality was 49% in the derivation cohort and 62% in the validation cohorts. A competing-risk regression model was used to screen potential predictors of mortality in the derivation cohort including age, sex, body mass index (BMI), smoking status, supplemental oxygen use, FVC, FEV1, TLC and DLCO. Age, sex, FVC% predicted and DLCO% predicted were identified as independent predictors and were used to develop the GAP individual risk calculator towards mortality and staging system. Three stages (stages I, II, and III) were identified based on the GAP index with 1-year mortality of 6%,16%, and 39%,

A systematic review undertaken by Smetana (2009) identifies postoperative respiratory failure as an example of cascade iatrogenesis i.e. serial development of multiple medical complications that can be set in motion by a seemingly innocuous first event. In this case, Mrs Hilton’s open cholecystectomy is that first event. Smetana (2009) points out that: when an older patient with postoperative pain is over-sedated, a decline in respiratory function occurs, that if not recognized, can result in respiratory failure that requires mechanical ventilation, that again, if not managed properly can culminate in ventilator-associated pneumonia and even sepsis and death (p.1529). After her upper abdominal surgery Mrs Hilton may have difficulty with deep breathing and coughing due to pain however both are essential interventions for prevention and treatment of respiratory infections and complications. Brown et al. (2008) recommend that when Mrs Hilton is awake, turning, coughing and deep breathing should be encouraged every one to two hours as this aids in the removal of secretions and prevents mucous plugs. They also encourage mobility when possible to increase respiratory excursion. Moreover, as Mrs Hilton

With reference to Biomaterials 1 set of notes, it states; “biocompatibility is the acceptance of an artificial implant by the body and its surrounding tissues. Biocompatible materials do not irritate the surrounding structures and do not cause cancer” (ME4307 notes). However, inserting an implant into the human body can result in one of four possible responses: encapsulation, integration, extrusion and resorption.

All the OI and ECV children had undergone only one polygraph study. The respiratory parameters of 3 ACH children who had had A&T before evaluation ranged as apnea-hypopnea index (AHI) 1.5-3.7 events/h and oxygen desaturation index (ODI) 1.1-2.6 events/h, considered as follow-up measures after surgery. Four ACH children (3 males; 3.3 y, 3.2 y, 3.6 y, and 2.6 y, respectively) with moderate-severe (AHI; 8.3, 20.1, 27.3, and 20.9 events/h) were immediately referred for surgery (A&T). One child (male, 2.6 y) was not available for follow-up after surgery because he was referred to another center. Figure 1 shows the plotted distribution of the AHI (events/h) and ODI (events/h) values, respectively, for the population studied, according to age at the time of

Growing up with asthma, I thought about doing a service learning outcome project dealing with asthma, but I knew that was too common. Therefore, I went into the internet and decided to make some research about diseases not many people were aware of, and that is how I found Trachoma. After deciding I would do my research based on trachoma, I went to Google Scholars, I was taught to use that website by my junior teacher for any research papers I had to do.

Normal respiration consists of inhalation and exhalation. Inhalation is taking in oxygen and delivering it to all cells in the body and exhalation is picking up carbon dioxide waster product of cells and taking it out. Air travel from the nose or mouth into the larynx into the trachea and ends up in the lungs where oxygen is dropped and carbon dioxide is picked up. Oxygen is really important for cell function and when oxygen is not delivered, cells begin to die. So when process of breathing does not work properly other methods of delivering oxygen are used such as tracheostomy.

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