Respiratory Management Following Spinal Cord Injury - 44
44
RESPIRATORY MANAGEMENT FOLLOWING SPINAL CORD INJURY
Appendix J: Evaluation of High Peak Pressure on Mechanically Ventilated Patients
The following protocol is a policy/procedure used by Craig Hospital, Englewood, Colorado (undated).
CAUSE—Increased Airway Resistance CORRECTION OR ACTION TO TAKE
Water in tubing Secretions or blood clot in or occluding tube Kinking in tube Narrow E-T tube • • • • • Decrease in compliance Pneumothorax ARDS Atelectasis Restrictive lung disease
More frequent draining Suction first; if not better, bronchoscopy or change tube Bite block, change tube Change to larger diameter E-T tube • Improvement of lung problem • Check CXR (this is indicated if there is a large, dramatic, sudden change in pressure) • Check static compliance Diuresis (physician to order) • Beta II drugs • Steroids (physician to order) • Attovent (physician to order) Change filter
Interstitial edema Bronchospasm (wheezing)
• Hygroscopic compressor • Humidifier (HCH) (humidity filter closest to patient’s E-T tube) CHANGE BOTH FILTERS AFTER ALL OTHER EVALUATIONS ARE MADE IF ALL ELSE FAILS, USE A NEW VENTILATOR WITH ALL NEW TUBING AND FILTERS BRONCHOSCOPY
WHEN IN DOUBT, CHANGE IT OUT—DO NOT COMPROMISE PATIENT USE MANUAL RESUSCITATION BAG ON 100% FiO2 WITH PEEP VALVE IF PATIENT IS ON PEEP, AND CALL FOR HELP If ventilator is changed out, DO NOT remove tubing as manufacturer may need to evaluate entire circuit and vent.
Respiratory Management Following Spinal Cord Injury
Table of Contents for the Digital Edition of Respiratory Management Following Spinal Cord Injury
Respiratory Management Following Spinal Cord Injury
Contents
Preface
Acknowledgments
Panel Members
Contributors
Summary of Recommendations
The Consortium for Spinal Cord Medicine
Recommendations
Recommendations for Future Research
Appendix A: Respiratory Care Protocol
Appendix B: Protocol for Ventilator-Dependent Quadriplegic Patients
Appendix C: Wean Protocol for Ventilator-Dependent Quadriplegic Patients
Appendix D: Wean Discontinuation Protocol
Appendix E: Cuff Deflation Protocol for Ventilator-Dependent Quadriplegic Patients
Appendix F: Cuff Deflation Discontinuation Protocol
Appendix G: High Cuff Pressures Protocol
Appendix H: Post-Tracheoplasty/Post-Extubation Protocol
Appendix I: Criteria for Decannulation of Trach Patients
Appendix J: Evaluation of High Peak Pressure on Mechanically Ventilated Patients
References
Index
Respiratory Management Following Spinal Cord Injury - Respiratory Management Following Spinal Cord Injury
Respiratory Management Following Spinal Cord Injury - Cover2
Respiratory Management Following Spinal Cord Injury - ii
Respiratory Management Following Spinal Cord Injury - Contents
Respiratory Management Following Spinal Cord Injury - iv
Respiratory Management Following Spinal Cord Injury - Preface
Respiratory Management Following Spinal Cord Injury - Acknowledgments
Respiratory Management Following Spinal Cord Injury - Panel Members
Respiratory Management Following Spinal Cord Injury - Contributors
Respiratory Management Following Spinal Cord Injury - ix
Respiratory Management Following Spinal Cord Injury - Summary of Recommendations
Respiratory Management Following Spinal Cord Injury - 2
Respiratory Management Following Spinal Cord Injury - 3
Respiratory Management Following Spinal Cord Injury - 4
Respiratory Management Following Spinal Cord Injury - The Consortium for Spinal Cord Medicine
Respiratory Management Following Spinal Cord Injury - 6
Respiratory Management Following Spinal Cord Injury - 7
Respiratory Management Following Spinal Cord Injury - Recommendations
Respiratory Management Following Spinal Cord Injury - 9
Respiratory Management Following Spinal Cord Injury - 10
Respiratory Management Following Spinal Cord Injury - 11
Respiratory Management Following Spinal Cord Injury - 12
Respiratory Management Following Spinal Cord Injury - 13
Respiratory Management Following Spinal Cord Injury - 14
Respiratory Management Following Spinal Cord Injury - 15
Respiratory Management Following Spinal Cord Injury - 16
Respiratory Management Following Spinal Cord Injury - 17
Respiratory Management Following Spinal Cord Injury - 18
Respiratory Management Following Spinal Cord Injury - 19
Respiratory Management Following Spinal Cord Injury - 20
Respiratory Management Following Spinal Cord Injury - 21
Respiratory Management Following Spinal Cord Injury - 22
Respiratory Management Following Spinal Cord Injury - 23
Respiratory Management Following Spinal Cord Injury - 24
Respiratory Management Following Spinal Cord Injury - 25
Respiratory Management Following Spinal Cord Injury - 26
Respiratory Management Following Spinal Cord Injury - 27
Respiratory Management Following Spinal Cord Injury - 28
Respiratory Management Following Spinal Cord Injury - 29
Respiratory Management Following Spinal Cord Injury - Recommendations for Future Research
Respiratory Management Following Spinal Cord Injury - Appendix A: Respiratory Care Protocol
Respiratory Management Following Spinal Cord Injury - 32
Respiratory Management Following Spinal Cord Injury - 33
Respiratory Management Following Spinal Cord Injury - Appendix B: Protocol for Ventilator-Dependent Quadriplegic Patients
Respiratory Management Following Spinal Cord Injury - 35
Respiratory Management Following Spinal Cord Injury - Appendix C: Wean Protocol for Ventilator-Dependent Quadriplegic Patients
Respiratory Management Following Spinal Cord Injury - Appendix D: Wean Discontinuation Protocol
Respiratory Management Following Spinal Cord Injury - Appendix E: Cuff Deflation Protocol for Ventilator-Dependent Quadriplegic Patients
Respiratory Management Following Spinal Cord Injury - 39
Respiratory Management Following Spinal Cord Injury - Appendix F: Cuff Deflation Discontinuation Protocol
Respiratory Management Following Spinal Cord Injury - Appendix G: High Cuff Pressures Protocol
Respiratory Management Following Spinal Cord Injury - Appendix H: Post-Tracheoplasty/Post-Extubation Protocol
Respiratory Management Following Spinal Cord Injury - Appendix I: Criteria for Decannulation of Trach Patients
Respiratory Management Following Spinal Cord Injury - Appendix J: Evaluation of High Peak Pressure on Mechanically Ventilated Patients
Respiratory Management Following Spinal Cord Injury - References
Respiratory Management Following Spinal Cord Injury - 46
Respiratory Management Following Spinal Cord Injury - 47
Respiratory Management Following Spinal Cord Injury - 48
Respiratory Management Following Spinal Cord Injury - Index
Respiratory Management Following Spinal Cord Injury - Cover3
Respiratory Management Following Spinal Cord Injury - Cover4
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