AboutHillarie Speziale Expertise I can answer general questions about ICU care, the frequently used medications, procedures, and life supports. I can also explain many of the diagnoses and supportive measures used for patients with that particular illness. I am familiar with the infectious, cardiac, pulmonary, renal, and gastric problems that can land you in the ICU. I can not tell you exactly how long the patient stay will be, diagnosis your symptoms, or tell you with any certainty that the care you (or your loved one) received was wrong. I can also answer career questions regarding RRT and RN fields. Please note: neurology is not a field I have a great deal of familiarity with..
Experience I have 17 yrs experience as a Respiratory Therapist, and 9 yrs as a critical care nurse. I am familiar with infectious, cardiac, respiratory, renal and gastric diagnoses that can land you in the ICU.
Education/Credentials Assoc. Degree in Respiratory Therapy, Bachelor of Science in Nursing, Master of science in psychiatric nurse practitioning.
Question My sister-in-law was admitted to ICU about 2 weeks ago with pneumonia, she has a hx with pneumonia, she's been admitted four times this year. She is a smoker. She has hep C. She overdosed on some type of pain medication she managed to get while in ICU and aspirated while eating. She is now on a vent and has been for 8 days. When they try to remove it her BP increases and her other vitals are negative as well. The pulmonary specialist has said that if they can't get her off the vent in the next week they will have to give her a trach. She has chemical burns in her lungs due to the stomach acid she aspirated. Can you tell me the rational behind this? Is it for suctioning? And what type of prognosis does she have with this type of procedure? She is 38. She is not overweight or sedentary.
Answer Hi Amber,
The rationale for the tracheostomy is to prevent damage to the trachea. Both of the tubes use a cuff that is inflated with air to keep a tight seal against her trachea. The cuff on the endotracheal tube that she presently has in uses a higher pressure over a smaller area. It works well for short term use. Over the long haul however, it can cause damage to the trachea and the vocal cords it bypasses. The tracheostomy cuff is slightly longer and uses a lower pressure. Additionally, with the endotracheal tube out of her mouth, her normal oral environment returns, meaning she can close her mouth again, her mouth and tongue will stay moister, and oral hygiene will be better. Her vocal cords will also return to normal. It is also possible, depending on the patient's recovery, for the patient to eat and drink with the tracheostomy in place. Finally, when your sister-in-law is ready to begin weaning from the ventilator, the tracheostomy, by virtue of the shortened airway, is easier for the patient to wean with, and easier to return the patient to the ventilator in the event the weaning fails.
It is easier to suction an intubated patient compared with a patient with out any tube, however I don't believe one tube is any easier than the other to suction through.
The tracheostomy will not have a negative impact on her prognosis in the least. If anything it will improve her chances of recovery for the reasons I explained above. The tracheostomy can be a temporary measure, and closes up rather quickly if no longer needed. Over all, it should prove to be a help much more than a hindrance.
good luck to her and you, take care, Hillarie
