1. Airway obstruction Trauma foreign bodies inflammation hematomas CNS disease secretions Drug overdose Infections glottitis Obstructive sleep apnea

2. Airway Protection May be impaired for similar reasons May decompensate with addition of varied bolus sizes and consistencies

3. Artificial Airways Rationale upper airway obstruction loss or impairment of airway protective reflexes inability to maintain clear airway (secretions) ventilator support

4. Maintaining a Patent Airway Maintaining a clear airway secretions inability can have drastic effects lung collapse hypoxemia laborious breathing

5. Skills needed for effective clearing mechanism (cough) deep breath competent glottis generate increased pressure vital capacity of 15 cc/kg

6. Ventilator Inability to maintain pulmonary function Apnea Acute ventilator failure increased CO 2 decreased pH Hyperventilation tracheostomy tube is required for ventilator function

7. Disadvantages Airway contamination Diminished cough Inability to vocalize Loss of control Increased difficulty swallowing

8. Types of Artificial Airways Endotracheal tube emergency surgical ICU Cricothyroidotomy emergency

9. Nasotracheal nonpreferred method oral cavity surgeries Tracheostomy long term intubation greater than 10 - 21 days

10. Tracheostomy Advantages lower risk of laryngotracheal injury improved comfort/mobility improve airway stabilization allows for oral nutrition improved secretion clearance

11. Potential problems (24 hours) pneumothorax hemorrhage subcutaneous emphysema infection tube displacement

12. Problems (long term) aspiration swallow dysfunction increased incidence of RTI and pneumonia tracheal stenosis a/o malacia TE fistula granulomas obstruction

13. Tracheostomy tubes Inner cannula Outer cannula Phalange Obturator Pilot balloon Cuffs high volume, low pressure low volume, high pressure

14. Changing trach tube malfunction infection more flexible weaning

15. Suctioning Complications hypoxemia hypotension slow heart rate prolonged coughing which slows rate arrhythmia lung collapse mucosal damage

16. Trach tube types Cuffed Cuffless Fenestrated Communication tubes Tracheal buttons