Tracheostomy Essay

Critically ill patients that require mechanical ventilation are at risk of developing secondary infections that may increase length of stay and possibly even morbidity. This fragile patient population requires special attention and meticulous adherence to established nursing standards of care. These standards of care are founded on evidenced based practices. It is important that nurses receive education about why these standards are in place and what consequences can result due to not following the established care protocols.

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).

I would tell the doctor to stop if he didn’t start and grab a manual ventilator and try to find a replacement mechanical ventilator.

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

Ventilator-associated pneumonia is the leading cause of death out of all hospital-acquired infections. Pneumonia that is acquired 48 hours or longer after at patient has been mechanically ventilated is considered hospital acquired. Endotracheal tubes provide pathogenic microorganisms’ with a direct access to the lungs where they can easily set up shop and cause deathly consequences for patients’ in the acute care setting. For example, the mortality rate of patients who have ventilator-associated pneumonia is 46% whereas unaffected intubated patients mortality rate is 32%. When ventilator-associated pneumonia (VAP) occurs in a patient(s), it often increases the amount of days a patient is on the ventilator and increases their overall hospital stay (Safe Care). The big problem with this is that VAP is costing hospitals

Respiratory emergencies can be caused by obstructions, inflammations, trauma, and several different disease processes. The most common obstruction of the airway is the tongue. This usually occurs when the patient has become unconscious secondary to another cause such as intoxication, low blood sugar, or trauma. While tongue obstruction of the airway can have deadly results, it can be easily solved by re-positioning the airway using the either the jaw thrust maneuver if trauma is suspected, or the head-tilt chin-lift if no trauma is suspected. Also if the patient is unconscious and has no gag reflex you can use an oropharyngeal airway to hold the tongue up and out of the airway. However, using an oropharyngeal airway does not mean that you can

Our patient was admitted to the ICU with respiratory distress. Respiratory distress is caused by an inflammation due to neutrophil activation. The body has an inability to transfer oxygen or carbon dioxide. This leads to increased permeability of A-C membrane, which then causes edema. Because of the edema, there is an increase in fluid in the peripheral areas and edema in hands, feet, and the scrotum. Decreased gas exchange also occurs because of the edema and mechanical ventilation is then implemented. The ventilator settings for our patient were: Rate 15, Peep 12, Peak Flow 60, FiO2 95, Flow Trig 1. Respiratory distress can also lead to multi organ failure if not treated; however, our patient’s respiratory distress resulted in

In the fast paced Trauma Intensive Care Unit (TICU) there are many things to remember while working with ventilated patients. Therefore, it is essential to implement practices that will decrease opportunities for adverse incidents. Ventilated patients represent about forty percent of the average daily census in the TICU. The Regional Medical Center at Memphis utilizes a ventilator bundle in order to decrease the risk of adverse events associated with the

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.

The optimal timing for elective tracheostomy is still a subject of debate. In the1980s, tracheostomy was considered “early” if it was performed within 21 days of endotracheal intubation. Otorhinolaryngology literatures recommended performance of tracheostomy within 3 days of intubation to prevent vocal cord damage from endotracheal intubation [13]. Several studies have shown early tracheostomy (within 7 days) reduced the duration of mechanical ventilation and the length of ICU stay as well as overall hospital length of stay in trauma patients [14]. The early tracheostomy group had a statistically significant lower incidence of pneumonia (78% vs. 96%, p < 0.05) compared to late tracheostomy (greater than 7 days) [14, 15, 16]. It is believed

The greatest advantage of fine needle aspiration is safety. Fatal complications like systemic air embolism , haemorrhage or pericardial tamponade have been described. However, pneumothorax remains the most common complication of CT-guided lung FNAC. Review of the existing literature reveals variable rates of pneumothorax, ranging from 5 to 64% . Pneumothorax was noted in 36.2% patients of my study population. In three patients (5.2%) moderate pneumothorax was seen requiring chest tube placement. It was found that the amount of lung traversed by the needle & size of the lesion is significantly associated with development of pneumothorax. The more the amount of the lung tissue traversed by the lesion the more was the complication rate and the

Children who may not live without the ventilator, go through the procedure of artificial airways and are very unstable, therefore patients have no choice of provider or hospital.

I feel that with experience and practice that any medical-surgical nurse can tackle any situation whether stopping fluid from leak out of an abdominal incision site to suctioning a tracheostomy patient. A nurse should address situation under pressure but remain calm and to be able to think of the next step.

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.

“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