No.4 (RT) CE Expired
• Tracheostomy in the Mechanically Ventilated Patient
• Postoperative Recovery in Elderly patients
• Obesity, the Lungs, and Airway Management
• Tracheostomy: Easing the Transition from Hospital to Home
• COPD in the Head and Neck Patient
• Preventing Ventilator-associated Pneumonia
Ventilator-Associated Pneumonia and Tracheostomy
Ventilator-associated pneumonia (VAP) is defined as a lower respiratory tract infection occurring at least 2 days after beginning mechanical ventilation. The estimated associated mortality rate is 24% to 50%. Because VAP is prevalent in ICU patients on mechanical ventilation, numerous studies have been undertaken to determine ways to decrease its incidence. One area of study surrounds the utility of early tracheostomy as a deterrent to VAP. The association of tracheostomy with VAP, the benefits of an early tracesotomy is the purpose of Dr. Durbin’s review.
Tracheostomy is an intensive-care measure that requires specialized care and monitoring. Despite its potential for reducing ventilator-associated pneumonia, it has its own risks, which are minimized by careful attention to device and patient care. In this issue of Perspectives, we have assembled a panel of experts to discuss trach care, strategies to minimize morbidity and mortality in this patient population, patient and family education, and decisions regarding weaning and decannulation. Differences in adult versus pediatric populations are also highlighted.
Respiratory Care of the Morbidly Obese Patient
Tracheostomy in the Obese Patient
The word obesity has its origins in the Latin language; it refers to the state of becoming “fattened by eating.” Obesity is a relatively common health condition, and its prevalence is increasing nationally and globally. Of all Americans between the ages of 26 and 75, 10 - 40% are obese, and nearly 5% are morbidly obese. The health consequences of obesity range from chronic conditions that reduce the general quality of life to a significantly increased risk of premature death. Along with other organs, the respiratory system is compromised by obesity. In their article, Gentile and Davies, discuss the many challenges to health professionals when caring for the respiratory needs of the obese, and how to reduce complications associated with their hospitalization. Critically ill morbidly obese patients are more likely to be intubated and remain intubated. They will stay in the ICU longer and are at risk for mortality during their stay when compared with their non-obese counterparts. In his article, Dr. Op’t Holt discusses the role of tracheostomy in the mechanically ventialted obese patient.