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
 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