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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