Artificial airways are used for:
1) For pts with airway obstruction
• Mid upper airway obstruction: oral/nasal pharyngeal mask or tubes
• More serious: Endotracheal intubation: if pt needs to
have mechanical ventilation.
• Tracheotomy-surgery in trachea used to maintain airflow, and respiration The plastic or metal tube is placed into the trachea For pts with oral/nasal issues or cancer of the larynx and need surgical change in the airway.
A tracheostomy is:
The opening in neck where the tube goes
Devices used to maintain exterior position of the tracheostomy tube are:
- Neck plate,
- Pilot balloon
- Pilot line
- Inflated cuff
- Tracheostomy tube
Effects of the trach tube on swallowing:
- Decreased laryngeal elevation
- Can desensitize the cough reflex to some degree
- At 6 mons.+ scar tissue tends to form and reduced TVC closure due to reduced sensory stimulation receptors under the TVC
- An inflated cuff trach may also put pressure on cervical esophageal wall impinging on bolus transport and causing excess pooling (likely a side effect of having a trach tube)
- Decreased subglottic pressure- which can effect activity of the VF
When is a trach tube used on ventilated pts.
- Used when the gas exchange is impaired
- Can be due to impairment of respiratory muscles( in the case of some kind of paralysis)
- cardiopulmonary disease or failure or neurogenic disease affecting respiration.
- Recall that gas exchange takes place in the aveoli
Respiratory muscles and supporting areas
-The diaphrag is the muscle below the lungs.
-Bronchioles are the smallest airways.
-Alveoli are the air sacs at the ends of the bronchioles. -The blood vessels surround the alveoli.
-The common wall between the capillaries and the alveoli is where the gas exchange happens.
(Because the interstium membrane is the membrane that is between the blood vessels and the alveoli walls is permeable, gas molecules can go back and forth across that membrane).
Gas exchange can be effected by:
The lack of the pressure changes in the lungs.
Typically, we use are muscles of respiration, to facilitate the flow of air in one direction or the other. If those muscles, especially the diaphragm or other inspiratory muscles and exhalatory muscles are not working, then some kind of mechanical means is needed to change the pressure inside the respiratory system.
What is a ventilator?
Mask or tube connecting the pt to a method of breathing.
What is a mechanical means of moving air in and out of the lungs called?
Ventilator- Delivers airflow via an endotracheal tube or tracheostomy tube. The tube is firm and inserted into the trachea through the mouth. End of attachment is diff on each pt.
What are some effects on ventilator dependency?
Pts can become ventilator dependent. They cannot breathe without the system set in place.
