Tracheostomy: A Qualitative Study

L.M. is a 75-year-old female who suffers from severe dementia and lives in a SNF. She was diagnosed with lung cancer in 2005 and as a result had a right upper and middle lobectomy. She also has a history of severe emphysema. L.M. has had several pneumonic infections and has an allergy to Pneumovax. She has a recurrent aspiration risk and received a tracheostomy and a PEG tube in January 2012.

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”

The rationale for this intervention is that humidification can help to thin tenacious secretions, lower the risk of mucus plug formation and allow for better expectoration and easier extraction via suctioning (Branson, 2007). This is particularly relevant for patients with tracheostomies since air entering their lungs is not warmed by the nasal turbinates and can lead to dry secretions that are hard to remove (Lewis, 2014). To implement this intervention I consulted the patient’s chart to confirm that this was recommended. I then attached the patient’s tracheostomy mask to a constant flow of warm humidified

Primary and long term treatment for CCHs is placement of a permanent tracheostomy. This most common invasive procedure involves the child being placed on positive pressure ventilation during the night. Depending on the severity of alveolar hypoventilation, some patients may require around the clock ventilation. The suggested ventilator mode for these patients iare spontaneous intermittent mandatory ventilation (SIMV). SIMV delivers a set number of fully assisted breaths whether the breaths are patient triggered, flow-limited trigger, or time-triggered. Additional spontaneous breaths by the patient are unassisted with no ventilator help. Ventilators should be used in the spontaneous intermittent mandatory ventilation (SIMV) mode. Another recommendation is the use of an uncuffed tracheostomy to minimize granuloma formation. Ventilator settings can compensate for air leaks around the tracheotomy tube by increasing volume and peak airway pressure as necessary. Mild hyperventilation in

Exclusion criteria included patients with BMI less than 30kg/m2 , younger than 18 year, hade ASA physical status IV or V, required a nasal intubation, , or were at risk of regurgitation and aspiration (hiatus hernia, not fasted, or esophageal reflux). Also, patients with anticipated impossible intubation will be excluded [as patients with a history of impossible intubation, mouth opening (interincisor distance) less than 20 mm, or cervical spine fixed in flexionwere excluded due to susceptibility of impossible intubation.

The purpose of this study was to look at how a detergent-enzymatic method was used to create a TET for application in an elderly patient with tracheal stenosis. Etiology of tracheal stenosis includes congenital malformations, inflammatory conditions, infections, neoplasm or secondary to iatrogenic causes such as prolonged intubation or tracheostomy. If the stenosis is limited to 50% of the total tracheal length, it can be treated with stenotic tracheal resection or slide tracheoplasty. However treatment of stenosis greater than 50% of the tracheal length is limited and requires alternative therapy such as TE.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is special type of method in which a tissue is taken from inside the chest cavity for examination. A bronchoscope, other than a normal fiberoptic bronchoscope is used. A kind of telescope, which is usually a flexible tube passes from the mouth into the airways and allows pulmonologists to visualize the lungs and perform the procedure. This procedure is a relatively new bronchoscopic method of visualizing the tracheobronchial tree, the surrounding pulmonary parenchyma and the mediastinal structures, with a particular role in lung cancer diagnosis, staging, and treatment, which was first reported by Yasufuku[9] in the year of 2004. For the operation being simple, minimally

“The indications for tracheal replacement are lesions a region in an organ or tissue which has suffered damage through injury or disease that can’t be resected and reconstructed safely with end to end anastomosis or long-segment congenital stenosis, which cannot be effectively managed with slide or patch tracheoplasty”, (Haykal et al., 2014). Acquired lesions include malignancy, traumatic injury, and subglottic or tracheal stenosis. The general limits for safe resection are about one half of the tracheal length in adults and one third in small children. Very lengthy lesions that cannot be safely removed and reconstructed primarily are managed palliatively with long-term T-tubes or stents. The clinical course of these patients is usually complicated with multiple infections and frequent hospital admissions. Therefore, a safe and dependable tracheal replacement remains an important unmet

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

Flexible bronchoscopy allows a full inspection of the central airways and has become the most commonly performed diagnostic procedure by the pulmonologists. The knowledge of airway anatomy is the most fundamental requirement of every bronchoscopist. Interestingly, normal endobronchial anatomy is an exception. There are numerous and frequent anatomical variations of the central airways making the examitaion unique for every individual. It is imparative for every bronchoscoipist to be fully cognizant of the common congenital anomalies involving the central airways. Proper idetification and reporting of these findings are matter of the utmost importance, especially when surgical option in lung cancer patient or the lung transplantation is under consideration. Each of these anatomical

and worked within a multidisciplinary team (ACORN Competency 9). In my rapid assessment of the patient I met Competency 4: Conducts a perioperative nursing assessment of the patient (ACORN 2014). Bevan (2012) supports my diagnoses, saying that partial airway obstruction such as this is characterised by noisy breathing or a crowing noise. Pritchard (2009) supports my actions stating that once any degree of obstruction occurs measures must be swiftly taken to create and maintain a clear airway. Bevan (2012) describes airway management as the cornerstone of effective postoperative care in the PACU. In accordance with Competency 2 (ACORN 2004) I considered it ethically right for me to take over the management of the airway as I had more experience

An inspection of Mr Brown’s airway was conducted for foreign bodies in the oropharynx, and breath sounds were listened to with Marshall and Hodge (2011:461) identifying that upper airway obstruction will be evident by snoring, stridor or gurgling noise on inspiration. Close observation of Mr Brown’s airway would be ongoing, with airway adjuncts such as guedals airway, oropharyngeal or nasopharyngeal airways suitable for use if his airway patency became threatened. Corley and Ringdall (2012:62) explain that endotracheal intubation is indicated in patients unable to maintain and protect their own airway due to reduced level of consciousness with Glasgow Coma Scale less than 9, risk of aspiration of blood or vomit or inability to maintain adequate

Nose and mouth warm and moisten the air that travels through them. It also helps with clearing out mucus secretion. Exclusion of the nose and mouth means a buildup of secretion in the oxygen cap. So, it is crucial to suction out secretions and clear the inner cannula carefully for any blockage or build up. Nurses have a huge responsibility when it comes to tracheostomy. They have to keep it clean, clear out secretions and care for surrounding tissue. They also have to consider about providing the individual with some way of

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