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 CO 2 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 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

Suctioning Complications 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