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Airway obstruction. Trauma foreign bodies inflammation hematomas CNS disease secretions Drug overdose Infections glottitis Obstructive sleep apnea. Airway Protection. May be impaired for similar reasons May decompensate with addition of varied bolus sizes and consistencies.
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Airway obstruction • Trauma • foreign bodies • inflammation • hematomas • CNS disease • secretions • Drug overdose • Infections • glottitis • Obstructive sleep apnea
Airway Protection • May be impaired for similar reasons • May decompensate with addition of varied bolus sizes and consistencies
Artificial Airways • Rationale • upper airway obstruction • loss or impairment of airway protective reflexes • inability to maintain clear airway (secretions) • ventilator support
Maintaining a Patent Airway • Maintaining a clear airway • secretions • inability can have drastic effects • lung collapse • hypoxemia • laborious breathing
Skills needed for effective clearing mechanism (cough) • deep breath • competent glottis • generate increased pressure • vital capacity of 15 cc/kg
Ventilator • Inability to maintain pulmonary function • Apnea • Acute ventilator failure • increased CO2 decreased pH • Hyperventilation • tracheostomy tube is required for ventilator function
Disadvantages • Airway contamination • Diminished cough • Inability to vocalize • Loss of control • Increased difficulty swallowing
Types of Artificial Airways • Endotracheal tube • emergency • surgical • ICU • Cricothyroidotomy • emergency
Nasotracheal • nonpreferred method • oral cavity surgeries • Tracheostomy • long term intubation • greater than 10 - 21 days
Tracheostomy Advantages • lower risk of laryngotracheal injury • improved comfort/mobility • improve airway stabilization • allows for oral nutrition • improved secretion clearance
Potential problems (24 hours) • pneumothorax • hemorrhage • subcutaneous emphysema • infection • tube displacement
Problems (long term) • aspiration • swallow dysfunction • increased incidence of RTI and pneumonia • tracheal stenosis a/o malacia • TE fistula • granulomas • obstruction
Tracheostomy tubes • Inner cannula • Outer cannula • Phalange • Obturator • Pilot balloon • Cuffs • high volume, low pressure • low volume, high pressure
Changing trach tube • malfunction • infection • more flexible • weaning
SuctioningComplications • hypoxemia • hypotension • slow heart rate • prolonged coughing which slows rate • arrhythmia • lung collapse • mucosal damage
Trach tube types • Cuffed • Cuffless • Fenestrated • Communication tubes • Tracheal buttons