Advanced Airways Flashcards
What is Endotracheal Tubes?
Maintains airway patency by ventilating to decrease O2 compromise
Used in emergency or early respiratory failure (either ventilation/oxygen failure)
What are the clinical considerations for Endotracheal Tubes?
Nasal vs Oral
Tube size/cuff inflation
Assessment before insertion
ETCO2 (end-tidal) monitoring
- Normal range 35-45
- <35 (hyperventilation, pul edema)
- <45 (hyperventilation, fever, Increased CO)
What is ETCO2?
End Tidal CO2 - Levels blows off during exhalation
Used to detect early obstruction, ventilation changes
And Apnea and placement for Endotracheal Tube
- Effective for CPR (emergencies like cardiac arrest)
- Normal range: 35-45
- <35: hyperventilation, PE, decreased CO
- > 45: hypoventilation, increased CO, fever
What is Tracheostomy Tubes?
Given to patients who required prolonged intubation (within 7-10 days of intubation)
D/t failure to wean from ventilator
What are the clinical consideration for Tracheostomy Tubes?
May Require OR
Various Sizes, material, and cuffs
Securement with tape or Velcro fastener
What is Artificial Airway Management?
Supportive equipment
O2 sources,
OPA (oropharyngeal airway)
Suction
Manual resus bag
PEEP attachment
Sedation
IV access
What is NIPPV?
Non Invasive Positive Pressure Ventilation
Does not require intubation
What are the Indications for NIPPV?
Acute Respiratory Failure, secondary to COPD
Acute cardiogenic pul edema
Immunocompromised pts, weaning facilitation
Limits risk r/t oral/nasal intubation
What are the contraindications for NIPPV?
Hemodynamically unstable
Cardiac Arrhythmias
Myocardial Arrhythmias
Apnea
Can’t clear their own secretions
Nausea with emesis
What is Continuous Positive Airway Pressure? (CPAP)
Patient must be able to spontaneously breathe
Attaches to O2
Used for obstructive sleep apnea
What is BiPAP?
Continuous pressure at exhalation, PEEP, Airway support
How does PEEP affect CO in 3 ways?
- Increased pressure in blood flow and into R Atrium. Right side is normally low pressure
- Negative pressure during inhalation in the thorax that pulls blood into the heart but with PEEP, the blood flow against resistance
- Right side of the heart has to pump against afterload to get blood into lungs
- Heart being squished by the positive pressure l/t decrease CO
How does PEEP affect Brain Perfusion?
- Increased thoracic pressure, makes it harder for JV to drain and therefore increases ICP
- Decreased CO means loss of blood flow to the brain
What are the complications with PEEP
- PEEP increases thoracic pressure to improve gas exchange
Complications:
- Decreases CO which decreases renal blood flow, cerebral hypoxia
- Increases ICP which l/t cerebral hypoxia
- Barotrauma: pneumothorax, subcut emphysema, pneumomediastinum
