Medicine and Health Sciences Commons^™

Complicated Extubation In A Patient With An Obstructing Tracheobronchial Thrombus, Milan Terzic, Daniel Aintabi, Omar Hegazy

Graduate Medical Education Research Journal

Endotracheal intubation is an effective and rapid technique used as a standard practice for airway management. Airway injury or complications could be a significant cause of morbidity and mortality for patients. Tracheobronchial obstruction secondary to thrombus formation are life threatening complications of traumatic intubations. We present a case of complicated extubation resulting in cardiac arrest in a patient with an obstructing tracheobronchial thrombus. The patient, an 83-year-old female, with atrial fibrillation presented for neck pain. During CT imaging, she developed ventricular fibrillation cardiac arrest. Return of spontaneous circulation (ROSC) was achieved after three cycles of compressions and defibrillation and the …

Implementation And Evaluation Of A Post-Op Coronary Artery Bypass Graft Extubation Checklist To Reduce Prolonged Intubation In The Intensive Care Unit, Melissa Bailey

Doctor of Nursing Practice Projects

Background: Total intubation time of post-op coronary artery bypass graft (CABG) patients is set by the Society of Thoracic Surgeons (STS) guidelines. STS states that post-op CABG patients need to be extubated within twelve hours of end anesthesia time with a recommendation of fewer than six hours. The project site had a total intubation time of greater than seventeen hours before removing the outliers. The current process does not result in a total intubation time of fewer than six hours. Implementation of an extubation checklist was chosen as the intervention for this DNP project.

Purpose: This DNP project aims to …

Factors Influencing Reintubation In Self Extubated Pediatric Intensive Care Unit Patients, Ahmed Naseem, Ameer Al-Hadidi, Morta Lapkus, Patrick Karabon, Begum Akay, Paras Khandar

Posters

NTRODUCTION
Intubated pediatric patients that self-extubate may be particularly susceptible to reintubation. Identifying factors that increase risk of reintubation allows for better monitoring and response in cases of self-extubation and can potentially identify patients needing reintubation.

Effectiveness Of Perioperative Ketamine Vs. Opioid Analgesia On Extubation Time And Total Perioperative Opioid Requirement, Robert H. Gray Srna, Sarah S. Hardesty Srna, Heidi E. Higginbotham Srna, Charles A. Hoyt Ii, Srna, Dwayne Accardo Dnp, Crna

Doctor of Nursing Practice Projects

Purpose/Background Opioid analgesics are a primary source of pain control in the perioperative patient. However, all opioids decrease ventilatory drive secondary to mu2 receptor agonism in the brainstem. Ventilatory depression delays extubation after mechanical ventilation in post-operative patients, thus increasing the risk of complications such as ventilator-associated pneumonia and barotrauma. Non-opioid analgesics such as ketamine have been considered for use in order to reduce this risk. Ketamine is a noncompetitive N-methyl-D-aspartate receptor-antagonizing sedative that bears analgesic properties while preserving respiratory drive. Research suggests that ketamine provides effective perioperative pain control and decreases postoperative extubation time when given alone or with …

Prophylactic Administration Of Steroids And The Effect On Post-Extubation Stridor: A Scoping Review, Chelsey Benson Bsn, Rn, Karlene Ferraro Bsn, Rn, Donna Lynch-Smith Dnp, Acnp-Bc, Apn, Ne-Bc, Cnl

Doctor of Nursing Practice Projects

Purpose/Background Stridor occurs due to laryngeal edema which arises when a patient has been intubated for an extended period of time. There are several factors that affect the degree of swelling. Post-extubation stridor signals that a patient requires reintubation because the airway is no longer patent. Corticosteroids, such as dexamethasone, can be used prior to extubation to minimize complications and overall length of stay if a patient is at high risk for stridor. This scoping review will evaluate the literature and the association between the use of prophylactic steroids on mechanically ventilated adult patients and the occurrence of post-extubation stridor. …

Endotracheal Tube Dislodgment In A High Risk Pulmonary Hypertensive Patient Due To Undiagnosed Tracheomegaly: A Case Report, Andrew Peck, Tammer N. Ghaly, Austin J. Adams, Daniel W. Johnson, Rebecca A. Aron

Graduate Medical Education Research Journal

Introduction

Airway enlargement was first described histologically in 1872, but it was not clinically reported until 1932, when Dr. Mounier-Kuhn published his seminal radiographic studies.¹ Since then, it is estimated that several hundred case reports have been published on congenital Mounier-Kuhn Syndrome (MKS), acquired tracheomegaly, and tracheobronchomegaly (TBM), yet only a few comprehensive literature reviews exist.²

Case

This case report details an elective nasal procedure for a patient with a history of significant pulmonary hypertension ad COPD on 5L home O₂ who had a symptomatic facial trauma. He was considered high risk secondary to his pulmonary disease, …

Increasing Extubation Awareness During Interdisciplinary Rounds With A Rounding Tool In The Pediatric Intensive Care Unit (Picu)., Lilly Giang

Doctor of Nursing Practice Papers

Purpose: Prolonged duration of mechanical ventilation and endotracheal tube intubation are associated with longer length of stay and increases risk for infection by about 3% per day when mechanically ventilated (Mirzarahimi et al., 2020). Evidence suggests that the use of a rounding tool during interdisciplinary rounds improves clinical outcomes, reduce duration of mechanical ventilation, and decrease length of stay in the PICU. The aim of the project was to measure registered nurses and PICU providers perception of the extubation prompts and determine if the extubation prompts decrease duration of mechanical ventilation and length of stay. Methods: After extensive review of …

Evaluation Of A Spontaneous Breathing Trial Extubation Protocol On Patient Outcomes, Joshua Caldwell

DNP Projects

Background: Evidence correlates better patient outcomes with shorter ventilator days therefore, without contraindications, patients should be removed from continuous mechanical ventilation as soon as safely possible. Exactly how to assess readiness to extubate and when to extubate is still up in the air.

Purpose: Evaluation of a 30-minute spontaneous breathing trial extubation protocol on patient outcomes and to also evaluate staff education of the 30-minute spontaneous breathing trial extubation protocol on adherence and patient outcomes

Methods: This is a retrospective and prospective evidence-based quality improvement project comparing patient outcomes before and after staff education as well as patient outcomes between …

Early Extubation After Cardiac Surgery: An Evidenced-Based, Nurse-Driven Protocol, Emily Brooks

DNP Final Reports

Prolonged mechanical ventilation in cardiac surgery patients has been associated with increased hospital stay, increased intensive care unit (ICU) length of stay, higher health care costs, and higher morbidity from atelectasis, intrapulmonary shunting and pneumonia. Early extubation of post-operative cardiac surgery patients has been associated with shorter ICU and overall hospital stays, reduced mortality, decreased resource use, and is safe and effective in elderly patients with no increased risk of reintubation. As such, the question arises in intubated post-operative cardiac surgery patients, how does a nurse-driven extubation protocol compared to no standardized protocol affect extubation rates within six hours post-operative? …

Increase In Intra-Abdominal Pressure During Airway Suctioning-Induced Cough After A Successful Spontaneous Breathing Trial Is Associated With Extubation Outcome, Lonny Ashworth

Respiratory Therapy Faculty Publications and Presentations

Background: A patient’s ability to clear secretions and protect the airway with an effective cough is an important part of the pre-extubation evaluation. An increase in intra-abdominal pressure (IAP) is important in generating the flow rate necessary for a cough. This study investigated whether an increase from baseline in IAP during a coughing episode induced by routine pre-extubation airway suctioning is associated with extubation outcome after a successful spontaneous breathing trial (SBT).

Methods: Three hundred thirty-five (335) mechanically ventilated patients who passed an SBT were enrolled. Baseline IAP and peak IAP during successive suctioning-induced coughs were measured with a fluid …

Prevention Of Unplanned Extubations, Melissa Fradette, Donna Kamps

Nursing Posters

Background: The trend of unplanned extubations is rising. Unplanned extubations are a safety concern for patients. A ventilator bundle is in place to guide nurses and respiratory therapists for weaning and extubating patients who meet criteria; it is not always being used. This concern has been discussed at the ICU safety team, ICU NP, ICU ROE, and ICU leadership meetings.

Genetic Variants Account For Differences In Responses In Blood Pressure And Blood Flow Values To Laryngoscopy/Intubation/Extubation, Hülya Gönen, Zeynep Kayhan, Fatma Belgi̇n Ataç, Ayşe Canan Yazici, Feri̇de İffet Şahi̇n

Turkish Journal of Medical Sciences

Aim: There is a variation in drug response among individuals. In this study, we determined angiotensin-converting enzyme (ACE) insertion/deletion (I/D), beta2-adrenergic receptor (ADRB2) Arg16Gly and dopamine D1 receptor (DRD1) -48 G/A polymorphisms, which are presumed to be related to the transient hypertension induced by the mechanical stimulation of laryngoscopy and tracheal intubation/extubation. Materials and Methods: One hundred American Society of Anesthesiologists (ASA) class I patients were enrolled in this study. Heart rate and blood pressure were recorded before induction (T_0), after induction (T_1), during laryngoscopy/intubation (T_i) and 1, 2, 3, 4 and 5 min thereafter (T_{i-1}-T_{i-5}), before extubation (T_e) and …

The Insecure Airway: A Comparison Of Knots And Commercial Devices For Securing Endotracheal Tubes, Paris B. Lovett

Paris B Lovett

The Insecure Airway: A Comparison of Knots and Commercial Devices for Securing Endotracheal Tubes

Paris B Lovett, Alexander Flaxman, Kai Sturmann;

Beth Israel Medical Center: New York, NY, University of Medicine and Dentistry of New Jersey–New Jersey Medical School: Newark, NJ

Background: ETTs are commonly secured using adhesive tape, cloth tape, or commercial devices. Adhesive and cloth tape have been reported equally effective, but there has been no experimental comparison of cloth tape tied with different knots. Movement of an ETT by 3cm may be life-threatening.

Objectives: To compare rates of failure of the following methods: cloth tape tied with …