Doctor insights on:
Endotracheal Intubation And Mechanical Ventilation
Simply: Intubation is placement of a tube in the trachea (wind pipe), mechanical ventilation is the process by which a patient receives oxygen using artificial means (a ventilator). Almost always, intubation is followed by mechanical ventilation and mechanical ventilation is performed most times after intubation. ...Read more
Depends on situation: Intubation by an anesthesiologist or nurse anesthetist is always done with careful preparation: suction equipment, a laryngoscope, different sizes of breathing tubes. Sometimes a fiberoptic scope or other advanced airway equipment is necessary. Anesthesia training prepares the team to assess the patient's airway and have all the proper equipment necessary for safe care. ...Read more
Supervised: A resident typically handles the entire endotracheal intubation process under the supervision of an attending physician. ...Read more
Depends on situation: In an emergency situation where the baby may be in distress, general anesthesia with intubation is often the fastest and most reliable choice. For an elective or less urgent csection, epidural or spinal anesthesia is preferred. Less medication reaches the baby, and the mother can be awake to see her baby right away. Talk to your anesthesiologist about anesthesia options for labor and delivery. ...Read more
Yes: Anaphylaxis in any situation can lead to rapid cardiovascular deterioration and death. If there are certain anesthetics or sedatives that cause anaphylaxis, you should make sure your doctors know before the need for intubation arises. ...Read more
Preemie intubation: Preemies are intubated with an endotracheal tube whose size is based on the baby's body weight. They are awake and sometimes receive some sedation when placed on a ventilator. If the intubation is just for surfactant administration and then the tube is removed they are not usually sedated. ...Read more
Most patients asleep: Putting a breathing tube into a patient's airway is not comfortable--think how irritating it is when even a drop of liquid goes down the wrong way! Most of the time, this is done after a patient is already asleep under anesthesia. Occasionally, local anesthesia is used to numb the airway if intubation needs to be done with the patient awake for special circumstances such as neck injury. ...Read more
Yes: It is done awake for specific reasons, these may include disrupted (broken) neck, such as related to trauma; anatomic, full stomach, need to neurologically assess after airway manipulation (such as make occur in c-spine surgery). Important technique for anesthesiologist to be comfortable with, patient is typically sedated and comfortable during procedure. ...Read more
Don't worry too much: If you need endotracheal intubation for general anesthesia, in order to under a surgical procedure, you should tell your anesthesiologist about your tmd. Your anesthesiologist should be able to modify the technique of intubation to minimize the risk of additional injury to your jaw joints. But if you really need surgery, then you will need to be intubated, regardless of your tmd, which may flare. ...Read more
It happens: Pneumonia, heart failure, stroke, & serious injury are some of the more common reasons; it's important to consider the goals of care & realistic expectations. Patients/family/power of attorney should make it clear what level of support they feel is acceptable. It's ok to make comfort a priority & say "no" to the ventilator. It's also ok to say "yes". Best to discuss this before the crisis. ...Read more
What are the benefits of a sigh breath during mechanical ventilation (v-simv). What is the normal calculated sight breath for a vented patient?
Sigh breath: The purpose of the sigh breath is to increase gas gas exchange and improve lung compliance. There are several studies looking at the addition of a sigh breath. One sigh breath every 60 to 90 seconds is what I customarily order. ...Read more
Do pts on long term mechanical ventilation (at a vent home) have to be sedated during ventilation hrs? If not, why sedated in hospital setting?
Depends on Pt., etc.: Sedation for the ventilated patient is dependent upon the patient (level of cognitive/ physical function and level of anxiety), the pt's comorbidities/active medical problems, and vent mode regardless of the setting. No two patients and their hospital courses are alike. Therefore, sedation and comfort plans should be pt.-specific with frequent assessment for appropriate modification if needed. ...Read more
Artificial respiratn: Simply put 'ventilating' or breathing for the patient 'mechanically'. These machines are getting more and more sophisticated and have a lot of settable and measurable data points. ...Read more
Why consider a tracheostomy if anticipated prolonged ventilatory support >2 wks? Why not continue mechanical ventilation? How is nutrition addressed?
Comfort: Tracheostomy is more comfortable for patient and may allow better pulmonary clearing, and should be considered if prolonged vent necessary. Feeding may be via IV of via soft tube through nasal passage down into stomach or small bowel or can also place feeding tube percutaneously into stomach or small bowel through abdominal wall. Nutrition key to weaning off vent. ...Read more
Baclofen overdose: Although 80 mg per day is a commonly accepted maximum, dosing up to 200 mg per day has been used safely and effectively. Baclofen is a great drug, but is also extremely deadly. The highest dose of baclofen ever recorded, 2 grams in a suicide attempt, btw patient has recovered. For Baclofen intoxication supportive care including mechanical ventilation is required. See your PCP ASAP. ...Read more
Mechanical ventilation - if you're old and don't want to be on a machine, what papers do carry on you?
Advance Directive: Advance directives & living wills are legal documents for you to instruct healthcare providers about what life-support measures you do or don't want. Your regular doctor can help you fill one out, or you can also get the forms from any hospital admitting office (you don't have to be a patient at the hospital, just ask for the form). Also talk with friends/family so they know what you want. ...Read more
When is it required to switch from endotrach tube to tracheostomy for an IPF patient who is on long term mechanical ventilation?
Trach and Vent mgt: It depends on the ICU and medical history and settings of the ventilator. One to two weeks on the ventilator is the usual time period before discussing tracheostomy. The tracheostomy has its own benefits and complications. Optimally, trying to wean off the vent and using BiPAP or CPAP may be considered. ...Read more
Many possible: Not just peep-peak and mean pressures also must be considered. High pressure can indicate inappropriately high volumes, leading to volutrauma/ventilator associated lung injury. Increased intrathoracic pressures can impair heart function (decrease preload), impair kidney function (decrease renal blood flow), and contribute to higher intracranial & intra-abdominal pressures. ...Read more
Indefinitely: Until a ventilator is available or the person is breathing on their own. ...Read more
Indefinitely: If you are able to continue bagging with reasonable volumes you could continue for an indefinite amount of time. ...Read more
Bagging: If performed properly, there is no time limit. ...Read more
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