The Routine Use Of Endotracheal Tube

Aspiration is another complication that is common among patients with feeding tubes. Aspiration is when food enters the lungs causing the person to choke. The reported

It is important to check the placement of the tube before suctioning or feeding, since

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 most common causes of an airway obstruction in unconscious patient's is their tongue. This problem can be overcome by the use of an oropharyngeal airway (OPA) or nasopharyngeal airway (NPA). These airway adjuncts are inserted into the patient's mouth or nostril, and are designed to hold the tongue in a position that prevents it from occluding the airway. Another skill authorized for BLS providers is the use of a bag-valve-mask (BVM). This tool allows EMS personnel to deliver positive pressure ventilations to a patient who is not breathing sufficiently on their own. However, this skill is commonly performed improperly. When using a BVM, an EMS provider must make certain that his patient's airway is patent, and that his head is positioned properly. Furthermore, it is critical that an EMS provider ensures that the mask is maintaining a complete seal around his patient's nose and mouth. Otherwise, pressure needed to force air into the lungs escapes through the unsealed portion of the mask, reducing the effectiveness of the ventilation. Another, more advanced skill used by EMS providers is the performance of an endotracheal

All patients were followed with pulmonary artery catheters and invasive blood pressure. After orotracheal intubation, patients were ventilated with intermittent positive pressure with a tidal volume of 8 mL / kg, final expiratory positive pressure of 5 to 8 cmH2O and FiO2 of 60 to 100% to maintain arterial oxygen saturation above 95%.

The mechanical insufflator-exsufflator, commonly known as the CoughAssist, is medical device that uses positive and negative air pressure to inflate and rapidly deflate the lung, thus simulating a cough and helping to clear secretions. It is commonly used in patients with impaired or no cough response. This includes patients with neuromuscular disease and muscle weakness related to nervous system injuries. Furthermore, it can be used in children as well as adults in the management of

Airway Pressure Release Ventilation (APRV) is an unconventional pressure controlled mode of ventilation that use inverse ratio strategy. Moreover, APRV based on the principle of open-lung approach, and it is a lung protective strategy mode. Therefore, one of the primary goals of APRV is to decrease the incident of Ventilator-induced lung injuries (VILI). Another purpose of APRV is that APRV aims to recruit the lung as well as to improve oxygenation. To illustrate, APRV creates continuous sequences of positive airway pressure that would significantly increase the mean airway pressure (Paw) which would lead to Lung recruitment and improve oxygenation. Furthermore, APRV helps to decrease the inflation/deflation process which contributes in avoiding alveolar derecruitment. In a similar way, APRV applies pressure to sustain FRC for alveolar recruitment. Finally, APRV helps patient to eliminate CO2 efficiently. On APRV, CO2 is washed during the release phase, and during spontaneous breathing as patients on APRV are allowed to breathe spontaneously at any time at the respiratory cycle on APRV. In Summary, The primary goals of Airway Pressure Release Ventilation are to minimize Ventilator-induced lung injuries cases, help to recruit lungs, improve oxygenation, avoid alveolar derecruitment, and eliminate CO2 efficiently.

Preoperative examination of the airway is essential. Identification of patients with a potentially difficult airway before anesthesia allows time to plan an appropriate anesthetic technique. Previous anesthetic records should always be consulted. However, a past record of normal tracheal intubation is no guarantee against difficulty on subsequent occasions as airway anatomy can be altered as in trauma affecting the airway. The presence of stridor or hoarse voice is warning sign for the anesthetist. As it is impossible to identify all patients with a difficult airway during preoperative assessment, the anesthetist must be prepared to manage the unexpected difficult laryngoscopy (Alan et al,. 2001).

Most patients undergoing general anesthesia for surgical procedures require mechanical ventilation. One of the biggest challenges facing clinicians providing mechanical ventilatory support today is managing the balance between providing adequate gas exchange and avoiding lung injury associated with positive pressure ventilation. Patients with respiratory failure need adequate tissue oxygenation and acid-base balance; however, the lungs are fragile structures that can be injured by over-distension, alveolar collapse and reopening, and high oxygen exposure. This challenge in providing “lung protective ventilation” is made more difficult by the fact that lung injury is often heterogeneous and thus what may benefit gas exchange in one region (e.g., higher pressure) may worsen injury in another.

This pressure is maintained until endotracheal tube placement is confirmed. The rationale is that the upper oesophagus is occluded by being compressed between the trachea and the cervical vertebrae, preventing passive reflux of gastric contents.

The use of tube feeding is done when a patient is no longer or unable to feed themselves orally. When tube feeding is required for just a short period of time an enteral tube feeding can be placed nasally. Incidences that require NG tube feeding would be prolonged bleeding, facial trauma, upper GI blockage and cancer. The NG tube catheter tip normally resides inside the stomach or in the small intestine past the pylorus. The number one complication involved with the use of NG tubal feeding is incorrect placement. A nurse can “inadvertently” place an NG catheter into the lungs, most notably when a patient has little to no gag reflex. As a result testing for gastric contents, pH or performing a chest x-ray are required once an NG tube has been inserted. Another major complication when using NG tubal feeding is aspiration within the lungs due to gastric “contents” enter the trachea and into the bronchial spaces of the lungs. Keeping the head of the bed elevated greater than 30 degrees will reduce aspiration at “minimum”. The use of a gastrostomy or jejunostomy tube can used for enteral feedings when an NG tube cannot be tolerated of interferes with therapy. The gastrostomy tube, PEG, tip is placed in the stomach and exits the body through the left upper quadrant of the abdomen where a bumper holds it into location. This can only be placed internally by a doctor during an endoscopy, radiology or surgery. A jejunostomy tube can be placed while in surgery, radiology

The flexible tubing connected to the humidifer delivers air to the patient through the mask. Make sure it has room to move freely when you turn on your side or move your head from side to side.

One lung ventilation (OLV) or lung isolation is a common term used in the practice of thoracic anesthesia. OLV refers to ventilation of one lung, while the other one is intentionally collapsed; thus, allows adequate surgical access for the surgeons (1- 6). Some indications for OLV are bronchopleural fistula, lung resection, single-lung transplantation, esophageal surgery, and open-chest aneurysm repair (3, 6). OLV can be accomplished by diverse techniques, two of which are either by using Double Lumen Tube (DLT) or Univent tube (3, 6- 10). the complications of using these tubes are vocal cord injuries, postoperative hoarseness, and sore throat (11). This dissertation will compare between the two tubes in terms of effectiveness in adult thoracic surgery.

In the 1961 Sellick described the practice of occluding the esophagus to assist in endotracheal intubation. He recommends placing anterior pressure on the Cricoid cartilage against the cervical vertebral bodies, occluding the esophagus, and leaving

placement with or without rescue adjuncts. They report that difficult airway situations occur more frequently in the pediatric population than adults. A large retrospective study analyzed intubations in 8,434 pediatric patients, reporting that the incidence of difficult intubation was 1.35% (Heinrich, Birkholz, Ihmsen, Irouschek, Ackermann, & Schmidt, 2012). They further broke down the data to show that patients less than a year old have higher rates of difficult airway, at 4.7% (Heinrich, Birkholz, Ihmsen, Irouschek, Ackermann, & Schmidt, 2012). The anatomical structure of the neonate airway is different from that of adults. The neonate larynx is located at C3-4 or as high as C2-3, which may have prevented tracheal intubation in this case (Belanger & Kossick,