Page 218 - Clinical Application of Mechanical Ventilation

184 Chapter 6

Stridor is heard when laryngospasm or laryngeal and subglottic edema occur. In minor
Stridor is the harsh or cases of stridor, use of a cool aerosol and 0.25 to 0.5 mL of 2.25% racemic epinephrine
high-pitched sound heard
during spontaneous respira- in 5 mL of saline may be helpful. Dexamethasone at 0.15 mg/kg may help prevent
tion and it is initially treated
with racemic epinephrine. worsening laryngeal and subglottic edema. In severe cases of laryngospasm, airway
obstruction may have developed and reintubation is often required (Whitten, 1997).

Following Extubation

Mucosal injuries, laryngeal stenosis, tracheal damages (inflammation, dilation, and
stenosis), and vocal cord paralysis are some long-term complications following extu-
bation. The best way to avoid these complications is to practice proper airway care
while the patient is intubated.

SUMMARY

The most important element of airway management is intubation. Esophageal intuba-
tion can be deadly and it must not be done under any circumstance (e.g., secretions in
the airway, poor view, or awkward patient position). The golden rule for endotracheal
intubation is “If you don’t see it (the vocal cords or related structures), don’t do it.”
Use of artificial airways also requires proper and routine maintenance to prevent
complications. Humidification, suctioning, cuff pressure, and unplanned extubation
are some important aspects in airway management during mechanical ventilation.
Since the artificial airway is inside the patient’s mouth and trachea and is not readily
visible, practitioners must have a keen sense of observation and timely clinical judg-
ment to detect any complications or potential troubles.

Self-Assessment Questions

1. The decision to intubate a patient is based on all of the following indications with the exception of:
A. airway obstruction. C. mechanical ventilation.
B. hypoxemia. D. removal of secretions.

2–5. Match the indications for using an artificial airway with the respective examples.

Indication Example

2. Relief of airway obstruction A. Absence of coordinated swallow

3. Protection of the airway B. Ventilatory failure
4. Facilitation of suctioning C. Excessive secretions

5. Support of ventilation D. Epiglottitis

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