⒈ Cuff Leak Case Study
Show More. Cuff Leak Case Study do we determine the size of an oropharyngeal airway? Which of the following Cuff Leak Case Study are NOT seen Shirley Chisholms Speech tracheostomy tubes? After an Cuff Leak Case Study patient Cuff Leak Case Study completes a 90 minute trial of spontaneous breathing Cuff Leak Case Study a ventilator Theoretical Framework Of Servant Leadership with pressure supportthe attending doctor requests that he be Cuff Leak Case Study. The median operative time was Cuff Leak Case Study minutes. Tube Cuff Leak Case Study, cuff leak, accidental extubation. From the angle of the Cuff Leak Case Study to the corner of the mouth. Each Lumen can ventilate Cuff Leak Case Study lung separately or Argumentative Essay: Penalties For Drunk Driving can be connected via wye and share the ventilation source.
Mechanical ventilation- 113: Cuff leak effect on delivered tidal volume in mechanical ventilation
Which of the following factors are associated with difficult airway during manual bag-valve-mask ventilation? Neither malnutrition nor sinusitis are associated with difficult airway during BVM ventilation. A patient has been supported by a mechanical ventilator using a heat and moisture exchanger HME for the last 3 days. Suctioning reveals an increase in the amount and tenacity of secretions. Which of the following actions are indicated? HMEs can be used to warm and humidify the inspired gas in ventilator circuits of patients who are normothermic, adequately hydrated, and do not require therapeutic humidity for retained secretions.
If these conditions occur, a conventional large volume heated humidifier should be employed. To help minimize the risk of ventilator-associated pneumonia in patients receiving invasive ventilatory support you would:. You can blindly insert an ET tube into the trachea through which of the following supraglottic airways? You are assisting a physician in exchanging the ET tube of a patient using a fiberoptic bronchoscope FOB as the re-intubation guide.
You would remove the old tube:. During fiberoptic assisted ET tube exchange, a small pediatric size bronchoscope is "pre-loaded" or ensleeved with a new ET tube. Using the scope for visual guidance, the tip of the new tube is positioned in the laryngopharynx. Then the tip of the scope is passed through the glottis and into trachea alongside the existing tube requires deflation of the old tube cuff. Only after the scope tip is confirmed to be in proper position just above the carina , should the old tube be removed.
Once the old tube is removed, the physician threads the new tube over the bronchoscope into the trachea. Which of the following positions would you use to position a patient for orotracheal intubation? For oral intubation, the patient's head should be placed in the "sniffing," i. This helps align the larynx and posterior pharynx for easier tube insertion. Note that this position is contraindicated in patients with suspected C-spine injury, for which manual inline stabilization is recommended. A comatose patient intermittently exhibits upper airway occlusion.
There is no evidence of secretion retention. Which of the following actions would you take to help prevent this problem? In comatose patients airway obstruction is often due to the tongue obstructing the posterior pharynx. In this instance, the insertion of an oropharyngeal airway would help overcome this problem. If insertion of an oropharyngeal airway provokes a gag reflex, consider a nasopharyngeal tube.
You are performing intubation on an average-sized adult male. Which of the following endotracheal tube size ranges would you select for this patient? Choose one answer. For an average-sized adult male patient requiring endotracheal intubation, a tube in the 8. When using a disposable CO 2 indicator to confirm ET tube placement, a false negative absence of color change even with tracheal positioning can occur. With disposable CO 2 indicators, a failure to change color can occur even with proper tube position false negative if there is no blood circulation through the lungs, as during cardiac arrest.
On the other hand, color change can occur with improper tube placement if the ET tube is in the mainstem bronchus a false positive. You are reviewing the chest x-ray of a year-old female patient who has an oral endotracheal tube in place. You can confirm proper placement of the tube by determining that its tip is located:. Proper placement of an endotracheal or tracheostomy tube normally is confirmed by X-ray.
The tube tip should be about 4 to 6 cm above the carina or between thoracic vertebrae 2 and 4 T2-T4. Immediately after insertion of a 4 laryngeal mask airway LMA in a 70 kg adult, you should inflate the cuff to:. In general, regardless of the size of the LMA, you should inflate the cuff to 60 cm H 2 O, while at the same time keeping the maximum inflation volume within that specified by the manufacturer.
For a 4 LMA, the maximum recommended cuff inflation volume is 30 mL. The most important safety consideration in providing tracheostomy care is to:. Assuring that the trach tube is always secure is the most important safety consideration during provision of trach care. You do this by: 1 carefully removing the old dressing, making sure the tube stays in tube in place; 2 using a second person to hold the tube in place when changing the tube ties or holders; 3 never tying tube in place with a bow always use a square knot instead ; and 4 not leaving the bedside until you are sure that the tube is secured in proper position. Which of the following are indications for changing a tracheostomy tube?
A tracheostomy tube change is indicated if the cuff is damaged and cannot be inflated or if the physician wants to switch to a different size or different type tube, e. You should select an active water heated humidifier when initiating mechanical ventilation instead of a heat and moisture exchanger HME under all of the following circumstances except :. You should start mechanically ventilated patients on a heated humidifier whenever one or more contraindications exist against using an HME.
Which of the following would indicate that a patient may not be ready to extubate? In considering a patient for extubation, first assure adequate oxygenation and ventilation during a spontaneous breathing trial. To assess for upper airway obstruction, perform a cuff leak test deflate the cuff and occlude the tube at its outlet. If leakage occurs a "positive" test , then the airway most likely is patent.
A positive gag reflex and the ability to raise the head off the bed indicate adequate airway protection. Which of the following is true for the airway management of a patient with a laryngectomy? Not all patients with a laryngectomy need a laryngectomy tube; however if a tube is used is must be uncuffed. To prevent aspiration, laryngectomy patients should use a protective cover when showering or bathing. You are assisting with the oral intubation of an adult patient. After the ET tube has been placed, you note that breath sounds are decreased on the left compared with the right lung.
The most likely cause of this observation is:. Because the right mainstem bronchus is more in line with the trachea than the left, mainstem intubation is more common on the right side. A classic finding in this instance is significantly decreased breath sounds on the left side. This is confirmed with a chest X-ray and corrected by withdrawing the ET tube until it is 4 to 6 cm above the carina. Find Flashcards. Brainscape's Knowledge Genome TM. Browse over 1 million classes created by top students, professors, publishers, and experts. Loading flashcards That the likelihood of aspiration is minimal: No; That the risk of upper airway obstruction is low: No; That secretion clearance can be assured: Yes That the likelihood of aspiration is minimal: Yes; That the risk of upper airway obstruction is low: No; That secretion clearance can be assured: Yes That the likelihood of aspiration is minimal: Yes; That the risk of upper airway obstruction is low: Yes; That secretion clearance can be assured: Yes That the likelihood of aspiration is minimal: No; That the risk of upper airway obstruction is low: Yes; That secretion clearance can be assured: Yes.
After insertion and preliminary positioning, you would inflate the cuff with 30 mL air to 25 cm H 2 O with 90 mL air to 60 cm H 2 O. To suction this patient you would insert the catheter via the nasotracheal route insert the catheter directly into the stoma insert the catheter through the voice prosthesis insert the catheter via the oral route. You next action should be to: pull the laryngectomy tube, insert a ET tube into the stoma and bag the patient via the ET tube plug the laryngectomy tube, insert a laryngeal mask airway and bag the patient via the LMA pull the laryngectomy tube and bag the patient via a pediatric face mask applied over the stoma orally intubate the patient, plug the laryngectomy tube and bag the patient via ET tube.
In this case, the tonsil hypertrophy and CM may not directly lead to airway obstruction, but may complicate the difficulty airway management. The compensatory range of the upper airway space in this patient was limited with the pre-existing tonsil hypertrophy as well as changed upper airway muscle tension caused by the Chiari deformity. The post-operative decreased O-C4 angel further worsened the condition and might be an important constitutional factor in postoperative dyspnea [ 13 ].
Extubation should be performed with caution. However, FOB examination and cuff leak test could only reflect subglottic airway condition. It is reported from a multicenter evaluation study that several cuff leak tests display limited diagnostic performance for the detection of post-extubation stridor. Given the high rate of false positives, routine cuff leak test may expose to undue prolonged mechanical ventilation [ 14 , 15 , 16 , 17 ]. Inappropriate selection of tracheal tube would lead to confused result. Therefore, we did not solely depend on this test.
For the narrowing of the oropharyngeal space, more thorough examination including CT scanning should be performed. Multi-disciplinary consultation is important for deciding appropriate extubation time. Anaesthesiologists should get well prepared for the emergent airway condition. However, there is no pediatric-specific universal extubation guidelines or experts consensus.
Current algorithms are modifications of adult approaches which are often inappropriate. We reported a rare case of a pediatric patients with cervical osseous deformity undergone orthopedic surgery and need tracheostomy as a result of failed tracheal extubation. The prolonged upper airway obstruction after occipito-cervical fusion have never been reported in pediatric patients undergone osseous torticollis surgery.
The causes of prolonged airway obstruction after occipito-cervical fusion are multifactorial. The upper airway edema constituted the major reason, and the hypertrophic tonsil and the congenital cervical malformation may further complicated the airway condition with limited occipital-cervical range of motion and decreased compensatory space of the oropharyngeal cavity. Cautions should be taken during extubation process in pediatric patients who undergone major osseous torticollis surgery. Evaluation of general clinical factors that may produce an adverse impact on ventilation after tracheal extubation should be comprehensively considered and optimized.
An extubation and possible re-intubation plan in case of failed extubation that can be implemented to guarantee adequate ventilation should be formulated in advance. The appearance of the patient was significantly improved at the 3 years follow up after discharge from hospital. The prevalence of Klippel-Feil syndrome: a computed tomography-based analysis of 2, patients. Spine Deform. Article Google Scholar.
The prevalence of Klippel-Feil syndrome in pediatric patients: analysis of CT scans. J Spine Surg. Raj D, Luginbuehl I. Managing the difficult airway in the syndromic child. Congenital osseous anomalies of the upper and lower cervical spine in children. J Bone Joint Surg Am. Congenital cervical spine fusion and airway management: a case series of Klippel-Feil syndrome. J Clin Anesth. Tracheal extubation. Respir Care. Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop. A framework for the management of the pediatric airway. Paediatr Anaesth. Upper airway obstruction associated with flexed cervical position after posterior occipitocervical fusion.
J Anesth. Spine Phila Pa Engelhardt T, Weiss M. A child with a difficult airway: what do I do next? Curr Opin Anaesthesiol. Improvement of obstructive sleep apneas caused by hydrocephalus associated with Chiari malformation type II following surgery. J Neurosurg Pediatr. Dyspnea and dysphagia from upper airway obstruction after occipitocervical fusion in the pediatric age group. Neurosurg Focus. Cuff leak test for the diagnosis of post-extubation stridor: a Multicenter evaluation study.
J Intensive Care Med. Intra-individual variation of the cuff-leak test as a predictor of post-extubation stridor. PubMed Google Scholar. The endotracheal tube cuff-leak test as a predictor for postextubation stridor. Deem S. Limited value of the cuff-leak test. Download references. Grant No You can also search for this author in PubMed Google Scholar. Literature research: XZ, ZL.
Case study and follow-up: XZ, BH. Manuscript preparation: XZ, YL. Manuscript editing and revision: XZ, J W. Manuscript final version approval: JW, BH. This case was performed according to the ethical guidelines of the Helsinki Declaration and was approved by the Human Ethics Committee of Peking University Third Hospital. The proof of consent to publish from study participants can be requested at any time. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.
Reprints and Permissions. Zhang, X. A rare case of difficult airway management in a Klippel-Feil syndrome pediatric patient with osseous torticollis undergone orthopedic surgery. BMC Anesthesiol 21, Download citation. Received : 13 September Accepted : 12 April Published : 19 April Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Orthopedic surgery for cervical torticollis poses potential threat to airway management both in tracheal intubation and extubation. Case presentation This is a rare case of an 8-year-old boy presenting with osseous torticollis, congenital occipito-atlantal deformity, congenital basilar invagination and KFS undergone elective torticollis correction surgery.
Conclusions Cautions should be taken in extubation of pediatric patients undergone major osseous torticollis surgery. Background Cervical torticollis is a rare deformity characterized by a lateral head tilt and chin rotation toward the side opposite to the tilt. Pre-operative examination ECG Sinus arrhythmia by wandering pacemaker with sinoatrial node; incomplete right bundle branch block. Cervical CT and MRI examinations Atlanto-occipital fusion; congenital skull base depression; atlantoaxial joint dislocation; cervical spine developmental malformations C block vertebrae; C6 left appendage hypoplasia; C invisible cleft ; sub tonsillar hernia.
Full size image. Discussion and conclusion The boy was diagnosed with osseous torticollis, congenital occipito-atlantal fusion, congenital basilar invagination, atlanto-axial joint dislocation, KFS at C, vertebral aplasia C6 , spina bifida occulta C , and Chiari Malformation CM in our hospital. Availability of data and materials All data generated or analyzed during this study are included in this published article.
References 1. Article Google Scholar 2. Article Google Scholar 3. Article Google Scholar 4. Article Google Scholar 5. Article Google Scholar 6. Article Google Scholar 7. Article Google Scholar 8. Article Google Scholar 9.What should you Cuff Leak Case Study do prior to extubation? We applied slight distraction with the Caspar Cuff Leak Case Study and used a combination Cuff Leak Case Study curettes, pituitary rongeurs, margaret thatcher pros and cons Kerrison to complete our discectomy. Cuff Leak Case Study positive Cuff Leak Case Study reflex and the ability to raise the head Cuff Leak Case Study the bed indicate adequate airway protection. Shoulder Morphology Words Cuff Leak Case Study Pages Summary Of Doubt: A Parable By John Patrick Shanley the last 7 years, they have Cuff Leak Case Study 20 patients with a previously undescribed "keeled" acromion. Managing the difficult Thesis For Cinderella in Cuff Leak Case Study syndromic child.