Why T Tube Did Not Impair Arterial Oxygenation Essay

10. Taking S.P.’s RA into consideration, what interventions should be implemented to prevent complications secondary to immobility?

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).

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

Although different kinds of tubes are placed in a patient at the bedside every day, it is important to remember the complications that can arise if a tube in not placed correctly or in the right place. Health care workers recognize this risk and take steps to ensure proper insertion. This study recommends that health care workers use at least two bedside methods to verify placement. These include, pH, visual signs of aspirate, patient’s respiratory condition, monitoring the tube every four hours, marking the exit location of the tube and capnography. These methods have all been backed by research to show their validity in determining tube placement. Although included on the list, the auscultation of an air bolus is not included in one of the recommended bedside tests. Although it is widely used in practice, the article states that “no evidence indicates that the auscultatory method is useful for determining the location” ( Methany 2016). If heath care providers relied on the auscultation method as one of the recommended bedside tests, the tube could be in the wrong place in the body or in the lungs. If feedings or medications were given through the tube in the wrong place it could lead to extreme complications or even death. This article notes x ray as, again, the gold standard for ensuring placement. This article along with several

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.

In this study, patients that had been ventilated in the intensive care unit from April to November of 2010 were included. There were few ways that the person could be excluded, these were if the patient had cardiac arrhythmias or severe obesity. All of the patients were monitored vary closely, such as with an electrocardiogram, invasive and non-invasive arterial pressure, and percutaneous

ation that I will be discussing is Airway Pressure Release Ventilation (APRV). I have not had an opportunity to use this mode, so I thought I would research it for this assignment. “The degree of ventilator support with APRV is determined by the duration of the two CPAP levels and the mechanically delivered tidal volume. Depends mainly on respiratory compliance and the difference between the CPAP levels. By design, changes in ventilatory demand do not alter the level of mechanical support during APRV. When spontaneous breathing is absent, APRV is not different from conventional pressure-controlled, time-cycled mechanical ventilation”( Putensen, C. )APRV is a form of improved pressure ventilation allowing unrestricted spontaneous breath at an

The determination of the potential for cardiac arrest is readily apparent in some patients. Patients with the greatest potential for cardiac arrest require close scrutiny for the signs and symptoms of respiratory and hemodynamic instability. This investigation will attempt to determine the best methods of administering high quality chest compressions in CPR. The PICO(T) acronym represents a format that can be used to create an answerable research question. The PICO(T) formulated question for this investigation is: In adult cardiac arrest, will the utilization of automated chest compressions compared to physical chest compressions during cardiopulmonary resuscitation improve survival outcomes? PICO(T) components consist of patient population (P), intervention (I), comparison (C), outcome (O) and time (T). The PICO(T) components used to formulate the answerable research question are: Patient population: adults in cardiac

The nature of the study recommended in the paper was to assess the effects of protocolized weaning from mechanical ventilation on the total duration of mechanical ventilation for critically ill adults and ascertain differences between protocolized and non-protocolized weaning in terms of adverse events, mortality, quality of life, weaning duration, intensive care unit (ICU) and hospital length of stay (LOS) and explore the variation in outcomes by the type of ICU, type of protocol and approach to delivering the protocol.

Moreover, a highly significant finding in the study found that in 14 tube-fed patients with PI and 12 tube-fed controlled patients

Arterial blood gases were compared before and after BiPAP ventilation in both Groups with reference to their Glasgow Coma Scale (GCS) . Mean and SD were calculated for quantitative vari¬ables. Paired `t’test and Chi-Square test were applied for comparison of relevant parameters.

CPAP acts to avoid airway narrowing by supplying positive pressure to mechanically splint the airway. This splinting pressure is constant and is optimized during sleep in order to be effective in preventing narrowing or collapse of the upper airway40. CPAP levels are typically set to raise the pressure level in the entire respiratory system to the level required to overcome any collapsing forces that result from the sub-ambient pressure generated during inspiration40, 41. However, this approach exposes the patient to pressure values that are higher than the pressure needed to support the airway for much of the breathing cycle. CPAP therapy ignores the variations in pressure requirements and provides splinting at a constant pressure level. Therefore,

A standard test for extubation readiness is the SBT performed using the T-piece by disconnecting the patient from the ventilator and providing additional oxygen.

| Weaknesses * < 40% of the blood collections in ROW were done using evacuated tubes