Ventilator-Associated Tracheobronchitis: A Case Study

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).

Adequate qualified medical staff must be present in all critical care areas caring for mechanically ventilated

Original research related to sedation management occurred in the year 2000 by Kress, Pohlman, O ' Connor, and Hall. Their findings served as a landmark study and initiated the impetus related to improving our sedation practices. According to Kress et al. (2000), daily interruption of sedation led to a decrease in the number of days on the ventilator in the intensive care unit. Several studies since this time have focused on the influence of sedation protocols, and outcomes. This paper will review the synthesis of the discovered studies and highlight the noted contraindications and inconsistencies. Also, explanations including a preliminary conclusion will be discussed.

Although when it happens, there can be a devastating impact on patients as well as to the multidisciplinary theatre team involved. Consequently, the DAS has produced a consensus set of guidelines for managing failed intubations in adult and paediatric patients, but there are as yet no such nationally-agreed guidelines in obstetrics, therefore each obstetric unit should have their own flowchart with regards to management of failed intubation (Brien and Conlon, 2013). Furthermore, in light of the latest DAS guidelines, several aspects of clinical anaesthetic practise have changed over recent years (Frerk at al, 2015). Amongst the changes are the use of new drugs such as rocuronium and suggamadex and using electronic video-laryngoscopes (Frerk et al, 2015). Further work had also looked at extending the period of apnoea without causing desaturation by optimising the preoxygenation process and adequate patient positioning (Frerk et al, 2015). As a result, updated guidelines for difficult intubations in adult patients were published in 2015; these guidelines provide a flowchart to be used when endotracheal intubation proves difficult or impossible and focus on the central importance of oxygenation while reducing the amount of airway interventions in order to minimize trauma to the delicate airway (Frerk et al, 2015). The main message of the revised guidelines is

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

The authors begin their initiation of the research article by stating their reason attention is needed to study the rate of accidental decannulation (AD). Due to the increment in the number of patients receiving protracted mechanical ventilation through artificial airway, much attention is needed to focus on how to reduce the morbidity and mortality rate of accidental decannulation. Not much recognition is given to the complications of AD compared to accidental extubation following translaryngeal intubation (White et al., 2012). According to the authors, the research was triggered by two sentinel events, hence a research for the identification of the causes of AD in LTACH and implementation of strategies to curb the situation.

Keywords: intensive care, patient scenario, clinical practicum, pathophysiology, disease processes, interventions, diagnoses, assessments, health prevention, promotion, health outcomes

Ventilator Associated Pneumonia (VAP) is the second most common infection that patients develop while in the hospital and the leading cause of death due to hospital acquired infections (Augustyn, 2007). Hospital acquired infections are also known as nosocomial infections. VAP usually happens when patients are on mechanical ventilation (the ventilator) for over 48 hours. VAP is costly because it increases the hospital length of stay, often times in the Intensive Care Units (ICU). Patients are often on the ventilator and are receiving antibiotics to treat the pneumonia. This paper will show that

Clinical problem: Oral care and ventilator-associated pneumonia (VAP) is extremely important in all healthcare organizations and has gained increased attention. For this reason, oral care has been introduced in many hospital settings. However, there is not enough evidence on critically ill patients concerning the effect of oral care interventions on the development of VAP. In order to evaluate the effect of oral care on VAP for hospitalized patients, additional studies are required.

Ventilator-associated (VAP) is the number one cause of health care associated infection in the intensive care unit. (ICU). It is a major cause of mortality in patients and increase in healthcare cost. Risk of VAP is increased in hospitalized patients in ICU unit on a mechanical ventilator. The risk may be due to inability of caring out good and adequate infection control measures to prevent the spread of disease. A reduction of VAP incidence in ICU setting could be accomplished by implementing Chlorhexidine gluconate oral rinse for decontamination.

Approximately half of smokers with chronic bronchitis will stop coughing after one month of smoking cessation. Most patients will no longer cough with continued abstinence from smoking. “People with chronic bronchitis are prone to contracting influenza and Streptococcus pneumoniae infections.” If airflow obstruction has occurred this can improve but the improvement level depends on the duration of injury and the compliance with therapy. Obviously, the more impaired patients will have a lesser recovery of lung function. Conversely, those individuals that have continued bronchial irritation have only a fair to poor prognosis, since repeated fight with the disease usually get worse, with affected individuals having more frequent incidents of coughing and dyspnea over time and further progression of lung function abnormalities. The overall 10 year mortality rate following the diagnose of chronic bronchitis is 50 percent, with respiratory failure following an acute exacerbation being the most frequent terminal event. Such acute exacerbation, are often precipitated by bacterial infection, manifested by purulent sputum, fever and a worsening of the symptoms of poor ventilation. Other known precipitants

tissue can be removed and examined, or an x-ray to examine for pulmonary edema, fluid

History of Present Illness: Ms. Leach is a very pleasant 85-year-old woman who was last seen by William Pease, DO for a history of bronchiectasis. Her bronchiectasis is very mild and predominantly basilar. She has had prior lobectomy secondary to multiple recurrent pneumonias and [_:30___] bronchiectasis. She has required no hospitalizations. Her symptoms are stable. She has a very minimal cough without sputum production. She does have some shortness of breath with exertion. Her dyspnea is complicated by chronic congestive heart failure.

Arterial blood gases (ABG) analysis is a common examination, which is carried out in the laboratory and clinical settings to monitor critically ill patients with acute renal failure and during situations such as post- cardiorespiratory arrest or respiratory compromise. (1). The usefulness of this diagnostic tool is dependent on the ability to interpret the results correctly which may be challenging. The results obtained from the test can provide vital information such as the level of oxygen delivery to the tissue, a sufficiency of ventilation and acid-base balance. ABG’s are usually analysed in high frequency and it is nurses who are commonly involved in measuring and analysing ABGs who then pass on the report to anaesthesiologist or doctor