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What are the two most common types of airway trauma that can occur with tracheal tubes?
1. Laryngeal lesions
2. Tracheal lesions
What are the 4 most common injuries to the larynx?
1. Glottic edema
2. Vocal cord inflammation
3. Laryngeal/vocal cord ulcerations
4. Vocal cord polyps or granulomas
(less common but more serious injuries vocal cord paralysis and stenosis)
What are the 4 types of tracheal lesions that can occur due to trauma?
3. Tracheal stenosis
4. Tracheoesophageal fistula
What is Tracheomalacia?
a weakness and floppiness of the walls of the windpipe (trachea), which is present at birth.
What is a "Granuloma"?
a mass of granulation tissue, typically produced in response to infection, inflammation, or the presence of a foreign substance.
what is "tracheal stenosis" ?
A narrowing of the trachea (windpipe) that is caused by an injury or a birth defect
What is a "Tracheosophageal fistula"?
A tracheoesophageal fistula (TEF) is a congenital or acquired communication (opening) between the trachea and esophagus. TEFs often lead to severe and fatal pulmonary complications
What are 5 ways to prevent trauma to the airway associated with tracheal tubes?
1. Tube movement is a primary cause of injury
2. Sedation can help avoid self-extubation
3. Nasotracheal tubes are easier to stabilize
4. Swivel adapter can reduce tube traction
5. Selection of the correct airway size is important
What is the purpose of sealing the lower respiratory tract with a cuff? (3)
1. Facilitates positive pressure ventilation
2. Prevents aspiration
3. Maintains delivered FI02
What are the 2 hazards of using a cuff?
2. tracheal stenosis
How much should a cuff be inflated/
must not exceed tracheal mucosal perfusion pressure of 20-25 mm Hg (25-35 cm H2O on manometers)
(must maintain less than 22 mmHg or 30 cmH20)
(do not inflate to these pressures if cuff seals at lower pressure)
What are 2 ways to measure and adjust cuff pressure?
1. In line pressure manometer ( three-way stopcock, pressure manometer, calibrated syringe)
2. Hand held cuff inflator (Manometer)
what are the two inflation techniques?
1. minimal leak (to get secretions out. means you hear air flowing past cuff w/stethoscope)
2. minimal occluding volume (aka minimal seal. No air leaking)
Name three alternative cuff designs that are meant to minimize mucosal trauma
1. High volume- low pressure cuff
2. Lanz cuff
3. Kamen-Wilkinson Foam cuff
Explain the "Lanz" cuff
it incorporates an external pressure regulating valve and control reservoir designed to limit the cuff pressure to 16 - 18 mm Hg, to minimize mucosal trauma.
Explain the "Kamen-Wilkinson Foam Cuff"
it is designed to seal the trachea w/atmospheric pressure in the cuff. First the cuff is deflated with a syringe, then once it is positioned, the pilot tube is opened to the atmosphere, and the foam can then expand against the tracheal wall. The expansion of the cuff stops when the tracheal wall is encountered.
What does it mean if you deflate the cuff, but there is still a seal? What should you do to fix this ?
Not a good sign! when a cuff is deflated there should be a leak. This means they may have swelling/ edema. Use cool aerosol or racemic epinephrine