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Lower airway bronchoscopic interpretation
Published in Don Hayes, Kara D. Meister, Pediatric Bronchoscopy for Clinicians, 2023
Kimberley R. Kaspy, Sara M. Zak
Tracheostomy tubesAcquired structural tracheal deformities can occur secondarily to having a tracheostomy tube.A tracheostomy tube, while necessary for breathing in patients that have them, is a foreign object in the airway and can lead to granulation tissue production, both above the stoma as well as at the distal end of the tube.Inflated tracheostomy cuffs can also cause erosion or irritation to the tracheal mucosa.Many patients who undergo tracheostomy placement can acquire tracheal stenosis at their stoma site, due to the collapse of a cartilage ring. This is often referred to as an A-frame tracheal deformity, named according to the shape it forms in the airway. This is shown in Figure 5.7.
Induction of Anesthesia
Published in Michele Barletta, Jane Quandt, Rachel Reed, Equine Anesthesia and Pain Management, 2023
Kristen Messenger, Rachel Reed
How to perform a tracheotomy: Clip the hair and aseptically prepare the skin on the ventral aspect of the neck, approximately 1/3–1/2 the length of the neck distal to the mandible.Perform local block with lidocaine over the area to be incised.Using sterile technique, make a vertical incision with a #10 blade.Bluntly dissect and separate the muscles.Identify the trachea.Make a horizontal incision between two tracheal rings.Insert and secure temporary tracheostomy tube.Provide supplemental oxygen as needed.
The patient with acute neurological problems
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
The patient’s verbal response is elicited through compulsory questions to establish whether the patient is orientated to person, time and place. The nurse must ask the patient their name and where they are. If the patient knows they are in hospital, the nurse should be more specific and ask the patient to name the hospital. Next, ask the patient to state the month; if the patient answers correctly, this indicates orientation to person, time and place and scores 5 for the verbal response (see Table 9.3). If the patient answers incorrectly to any of the three questions, they should be scored as confused, even if they are able to speak coherently. For example, the patient may be in hospital, but might think they are at home; the answer is relevant to the question but incorrect, so they will score 4 for confusion. If the patient answers with words and lacks sentence structure or phrases, it is classified as ‘words’ and scores 3 points. Unintelligible speech, making sounds, not words, classifies the response as ‘sounds’, scoring 2 points. If there is no verbal response at all, the patient scores 1 point (Teasdale et al. 2014). Patients may be unable to speak because of intubation or a cuffed tracheostomy tube; these patients have no air flow through their vocal cords. In this situation, the nurse annotates the score as ‘not testable’ (NT).
Tracheostomy management by speech-language pathologists in Sweden
Published in Logopedics Phoniatrics Vocology, 2022
Sara Wiberg, Susanna Whitling, Liza Bergström
A tracheostomy tube in situ is often associated with dysphagia and impaired airway protection. Whether the tracheostomy tube itself causes impaired swallowing function has been debated. Some studies show that the tracheostomy tube leads to reduced ability to build subglottic air pressure when swallowing with an open tracheostomy tube, reduced glottic closure, desensitization of the larynx, discoordination of swallowing with respiration and reduction of laryngeal elevation [9]. However, other studies have found no significant changes in swallowing or aspiration due to tracheostomy tube [10–12]. Leder et al. [11] reported that the tracheostomy tube may affect swallowing function, but that it is the underlying cause for needing tracheostomy that causes dysphagia and not the tracheostomy in itself. SLPs dysphagia management including bedside FEES can be used to identify risk of aspiration, readiness for cuff deflation and weaning [8,13–15].
Early rehabilitation of Disorders of Consciousness (DOC): management, neuropsychological evaluation and treatment
Published in Neuropsychological Rehabilitation, 2018
Caterina Pistarini, Giorgio Maggioni
The weaning from supported ventilation to a spontaneous one is mandatory to allow rehabilitation in an adequate setting. Afterward when the patient is hosted in a rehabilitation unit, other problems can arise, such as an incorrect management of the tracheostomy tube. This, in fact, is one of the main factors responsible for AE, infections or swallowing impairments. Only a few studies have considered criteria for methods and timing of weaning during the ER phase and removal of the tracheostomy tube in patients with DOC (Choate, Barbetti, & Currey, 2009) (Frank, Mader, & Sticher, 2007). The studies reported in the literature are not even strictly related to patients with DOC (Littlewood, 2005) (Stelfox, Hess, & Schmidt, 2009). Even before 2005 (starting date for our literature review), few studies had been published (Karen, Cohen, Lazar-Zwer, & Grosswasser, 2001). Despite these limitations, a few recommendations emerge: (i) avoid cuffed tracheostomy tubes as much as possible; (ii) remove the tracheostomy tube under progressive clinical evaluation; (iii) consider the presence of efficient cough; (iv) use fiberoptic endoscopy study (FES) to evaluate glottic and supraglottic spaces for detecting possible stenosis, granulomas or tracheomalachia.
Section 5: Airway clearance
Published in Canadian Journal of Respiratory, Critical Care, and Sleep Medicine, 2018
Suctioning via catheter is effective at removing secretions from the large airways in individuals with artificial airways.64,65 This practice is largely guided by clinical experience, rather than rigorous clinical studies, which are lacking to inform this practice. However, techniques to mobilize secretions from the peripheral airways are still needed. Suctioning is not a benign intervention and deep suctioning has been associated with airway trauma, alveolar collapse and hypoxemia.66 Shallow, minimally invasive suctioning, to the tip of the tracheostomy tube, is preferred.64,67 The recommended suctioning technique includes use of a “premeasured” catheter with side holes close to the distal end (0.5 cm or less) of the catheter tube, inserted to a premeasured depth so that the most distal side holes just exit the tip of the tracheostomy tube.64 It is recommended that the largest size catheter that fits inside the tracheostomy be used and that a rapid technique, completed in less than 5 seconds, be employed.64 Deeper suctioning may occasionally be necessary, for example, in the presence of a mucus plug below the level of the tracheostomy tube.67