By L. Jill Krasner, Neil W. Brister (auth.), Gerard J. Criner MD, Gilbert E. D’Alonzo DO (eds.)
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Additional resources for Critical Care Study Guide: Text and Review
Short periods of intubation are usually well tolerated without major complications. Factors leading to laryngotracheal stenosis include direct pressure necrosis from the cuff material and high pressures, duration of intubation, macro- and microtrauma during intubation, the intubation technique used for placement oftheETT, the degree of respiratory failure, infection, and poor tissue perfusion. Endotracheal Thbe Changes Endotracheal tube changes should be done only when necessary and only under the supervision of experienced personnel.
MAINTENANCE OF ENDOTRACHEAL TUBES Once placed, the endotracheal tube is subjected to the dynamic changes of patient pathophysiology as well as medical therapy. Although this statement seems obvious, it is important to remember that the piece of plastic serving as an airway is prone to complications if not well managed. Inspissated secretions can block the tube, inhibiting exchange of oxygen and carbon dioxide. The endotracheal tube can slip down into the right mainstem bronchus with neck flexion or can slip out of the trachea with neck extension.
Patients are more comfortable without a tube in the posterior oropharynx. It is considerably easier to reconnect a patient with a tracheotomy to the ventilator if weaning trials fail than to reestablish an airway with an ETT. Therefore, although it is a surgical procedure and in most cases requires exposure to an anesthetic, the overall advantages of the procedure usually outweigh the basic risks of the surgery. It is well recognized that with certain types of strokes patients have limited ability to protect the airway due to loss of airway reflexes.
Critical Care Study Guide: Text and Review by L. Jill Krasner, Neil W. Brister (auth.), Gerard J. Criner MD, Gilbert E. D’Alonzo DO (eds.)