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Discussion

Question about an interesting case

I had a patient the other day who was admitted with aspiration pneumonia and had to be intubated. After several days on the vent she was weaned and that is when it became evident that her airway was swollen from the intubation. She was reintubated and put back on SIMV w/CPAP. Her x-rays now show that the infiltrates have cleared, breath sounds good, O2sat good. BP and C. diff infection being treated. ESRD. She got a trach after having the ET tube for 2 wks.

I'm basically wondering if anyone has an idea of what the plan for this patient would be (recovery time, d/c planning, etc). Obviously her airway has to heal, but I'm just learning about mech. ventilation and trying to get an idea of what the care for this patient would consist of until then. I know RT does a lot. Thanks for any comments/opinions.

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    • Experts

    Several questions come to mind.....are you sure it was that her airway was swollen from intubation or she just couldn't ventilate. If the airway was swollen did they try IV steroids or racemic epinepherine? what was the cause of the aspiration?

    More likely she failed exutbation as a result of the aspiration PNA and what ever caused her to aspirate in the beginning . They were afraid, or she couldn't, protect her airway.

    What are the doing for the ESRD? Are they on dialysis? Once trached the patient can be weaned. This varies patient to patient. Sounds like she will go to an LTAC for rehab.

    Recovery time? Unable to be determined. This depends on patient age, co-morbidities, and the big Guy upstairs, the powers that be.

    Weeks to months.

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    When you're planning her nursing care, what have you thought about that would make her more comfortable, safer, and less physiologically stressed?

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    • Author

    Not sure what all they tried because I didn't find that in the report and the nurses didn't know. I don't know how she aspirated, but I was told when she was extubated she developed strider and was reintubated. The nurse said doc thought et tube was too large and that sometimes very small patients have this reaction to intubation.

    She is dialysis 3X per week.

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    • Author

    "More likely she failed exutbation as a result of the aspiration PNA and what ever caused her to aspirate in the beginning . They were afraid, or she couldn't, protect her airway."

    Can you explain what you mean by aspiration PNA and trouble extubating because of what caused her to aspirate?

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    • Experts
    "More likely she failed exutbation as a result of the aspiration PNA and what ever caused her to aspirate in the beginning . They were afraid, or she couldn't, protect her airway."

    Can you explain what you mean by aspiration PNA and trouble extubating because of what caused her to aspirate?

    Well something caused her to aspirate. Does the patient have swallowing difficulty that would cause them to aspirate food? Did they vomit and was unable to move to prevent them from protecting their airway? Are they of a decreased LOC or cognitive ability that makes swallowing difficult?

    So if she aspirated food which caused her PNA when they extubated her they discovered that she cannot protect her airway.

    If this patient has difficulty swallowing and cannot protect the airway and the problem is such that when they extubated she failed in the ability to keep herself from choking and the ability to protect her airway OR she was still too weak to breathe on her own.

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    • Experts
    Not sure what all they tried because I didn't find that in the report and the nurses didn't know. I don't know how she aspirated, but I was told when she was extubated she developed strider and was reintubated. The nurse said doc thought et tube was too large and that sometimes very small patients have this reaction to intubation.

    She is dialysis 3X per week.

    Some patients will develop stridor post extubation. Some stridor/airway obstruction is severe enough that occlusion of the airway is a likely outcome
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    PNA = pneumonia. :) Aspiration pneumonia is inflammation and infection in the lungs due to food or secretions or other stuff getting in there for whatever reason-- unconsciousness, stroke, airway damage, weakened or loss of cough reflex, anything that removes the natural airway protective mechanism that makes you cough your brains out when you inhale your orange juice by mistake.

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