Ventilation Part 3

Question 1

What is the soft balloon around the distal end of the tube that can be inflated to seal the TRACHEA?

Answer 1

cuff

Question 2

What does the cuff do?

Answer 2

1. maintains position

2. prevents secretions from entering lungs

Question 3

Why should over-inflating the tracheostomy tube cuff be avoided?

Answer 3

too high a pressure in the cuff against the trachea wall can cause damage

Question 4

What two techniques can help avoid excessive cuff pressure?

Answer 4

1. Minimal Occluding Volume

2. Minimal Leak Technique

Question 5

What is the Minimal Occluding Volume technique?

Answer 5

inflating the cuff while listening to the side of the patient’s neck with a stethoscope, keep injecting air (or water) until you can no longer hear air going past the cuff

Question 6

If a patient is completely ventilation dependent, what should you do?

Answer 6

provide breaths with manual resuscitator while listening with the stethoscope and inflating the balloon

Question 7

How is Minimal Leak Technique for cuff inflation completed?

Answer 7

same as Minimal Occluding Volume except once cuff is sealed, slowly withdrawal small amour (1cc) so that a slight leak is heart at the end of inspiration

Question 8

When giving Trach Care, what should you NEVER do?

Answer 8

dry the inner cannula - lent can stick to it and then go into patient’s lung

Question 9

Is Trach care a sterile or clean procedure?

Answer 9

STERILE

Question 10

What are the 6 complications seen with Ventilation?

Answer 10

1. Decreased CO
2. Oxygen Toxicity
3. Barotrauma
4. Gastric Distention
5. Infection
6. Positive Fluid Balance

Question 11

How do we know patient is getting oxygen toxicity?

Answer 11

Increased blood gasses (PaO2, SpO2)

Question 12

When does Barotrauma occur?

Answer 12

When patients have thin portions of their lungs (from COPD, etc.)

Question 13

What is Barotrauma?

Answer 13

When the pressure of oxygen delivery is too high and we blow a “bleb”

Question 14

How is Gastric Distention caused?

Answer 14

oxygen is delivered under to much pressure or intubation goes in the wrong place (esophagus)

Question 15

How is Gastric Distention treated?

Answer 15

dropping NG tube and relieving pressure

Question 16

Is gastric distention common with intubation?

Answer 16

it is inevitable to not have some gastric distention but the longer they are intubated the worse it gets

Question 17

Why is mouth care VERY important?

Answer 17

to prevent VAP

Question 18

What causes Positive Fluid Balance?

Answer 18

ventilation increased ADH, leading to water retention

Question 19

What is very important to monitor to prevent positive fluid balance?

Answer 19

strict I & Os

Question 20

What are the psychosocial issues with intubation?

Answer 20

inability to communicate

fear of being sick enough to require ventilator

Question 21

What are the complications of over-inflation of the cuff?

Answer 21

tracheal:

1. ischemia
2. necrosis
3. tracheomalacia
4. stenosis
5. tracheal-esophageal fistulas

Question 22

What is damage to the trachea when the cuff decreases the flow of blood surrounding the cuff?

Answer 22

tracheal ischemia

Question 23

What is death of tissue in the trachea due to compression by the cuff?

Answer 23

Tracheal Necrosis

Question 24

What is a structural abnormality of the tracheal cartilage, allowing collapse of the walls and airway obstruction?

Answer 24

Tracheomalacia

Question 25

What is a deficiency and/or malformation of the supporting cartilage with a decrease in cartilage-to-muscle ration?

Answer 25

Tracheomalacia

Question 26

What is causes Trachea Stenosis?

Answer 26

pressure exerted on the tracheal mucosa at the cuff

Question 27

What cuff pressure exceeds the mucosal capillary perfusion pressure, causing mucosal ischemia?

Answer 27

greater than 30 mmHg

Question 28

What will mucosal ischemia lead to?

Answer 28

ulceration and chondritis of the tracheal cartilages

Question 29

When the ulcerations and chondritis of the trachea heals by fibrosis, what does this lead to?

Answer 29

tracheal stenosis

Question 30

What is an opening that develops between the trachea and the esophagus, usually resulting int tracheal ischemia or necrosis?

Answer 30

Tracheal-Esophageal Fistulas