BUMC Basics.pdf - Anesthesia Home

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• After 1 wk of intubation determine likelihood of
extubation at 2wks. If unlikely proceed with
bedside/surgical tracheostomy with a GS
• Tracheostomy may be beneficial because it is more
comfortable, more ease in clearing secretions, decreased
airway resistance, decreased laryngeal injury, can eat
orally, can partially vocalize, etc.
- Complications: Infection (mediastinitis), bleeding,
accidental removal with closure of stoma and then
blind reinsertion potentially creating a false tract,
injury to surrounding structures
- Consider a Passy-Muir valve when a patient has a
trach after weaning off ventilator to help with talking.
The Passy-Muir valve acts as a one-way valve
allowing air to go in through the trach and be exhaled
through the native airway.
- You can put a red cap over trach and see if pt can
breath/talk fine, and, if so, you can decanulate the
patient (the hole closes on its own in 2-3d)
Oxygen Toxicity — Remember oxygen toxicity (FiO2 >60%
for >48hrs) from the production of oxidizing radicals which
damage membranes, denature proteins, and break DNA
Cardiac Output Changes — Can reduce cardiac output
because of decreased venous return and increase right
ventricle afterload
Respiratory Muscle Atrophy
Trauma to Airway, Dentition, etc
ETT Migration (normally the tip of the ETT should be 2cm
above carina)
Critical Illness Polyneuropathy/Myopaythy
• Consider when patients continually need MV despite
resolution of primary problem
After Extubation
• Sore throat, Hoarseness, Cough, etc: Can be normal
and should resolve.
• Laryngeal Edema
- Usually occurs when patient is extubated from 2-
7days post-extubation. After extubation, an average
of 40% of patients have laryngeal edema but only 5%
having severe obstruction