Resp Care
-
Editorial Comment
Inhalers in asthma management: is demonstration the key to compliance?
-
Historical Article
Ventilator-induced lung injury: from barotrauma to biotrauma.
-
The trachea is easily accessible at the bedside. As such it provides ready access for emergency airway cannulation (eg, in the setting of acute upper airway obstruction) and for chronic airway access after laryngeal surgery. More commonly, tracheostomy tubes are placed to allow removal of a translaryngeal endotracheal tube. ⋯ The most recent and methodological robust studies indicate that these tubes reduce resistive and elastic work of breathing, when compared to endotracheal tubes. This is a result of tracheostomy tubes lessening inspiratory and expiratory airways resistance and intrinsic positive end-expiratory pressure. Whether these physiologic benefits are of clinical importance in enhancing weaning success remains to be elucidated.
-
Tracheostomy may be associated with numerous acute, perioperative complications, some of which continue to be relevant well after the placement of the tracheostomy. A number of clinically important unique late complications have been recognized as well, including the formation of granulation tissue, tracheal stenosis, tracheomalacia, tracheoinnominate-artery fistula, tracheoesophageal fistula, ventilator-associated pneumonia, and aspiration. ⋯ Treatment modalities vary depending upon the nature of the complication. For the most frequent complication, tracheal stenosis, a multidisciplinary approach utilizing bronchoscopy, laser, airway stents, and tracheal surgery is most effective.