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Contents
x
Care for Patients at Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Clinical Follow-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Key Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Contributors
Michiel J. Bové, MD
Assistant Professor of Otolaryngology
Northwestern University Feinberg School of Medicine
Chicago, Illinois
Jeri A. Logemann, PhD, CCC-SLP, BRS-S
Ralph and Jean Sundin Professor
Department of Communication Sciences and Disorders
Northwestern University
Evanston, Illinois
John Parson, BA, RRT
RIC Administrator, Respiratory Care
Rehabilitation Institute of Chicago
Chicago, Illinois
Linda Sue Van Roeyen, MS, CSN, CCRP, CFNP
Nurse Practitioner, Pulmonary Habilitation Program, Transitional Care Unit
Department of Critical Care
Children’s Memorial Hospital
Chicago, Illinois
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Preface
The first edition of this clinical resource is written for health care professionals of all disciplines who care for patients with tracheostomies. The nature of
compartmentalized care in medicine today does not allow for a clear overview
of the continuum of care for a patient with a tracheostomy. Surgeons are skilled
in the procedure of placing a tracheostomy but are often unaware of the myriad
of tubes available and the advantages and disadvantages of each. Intensivists
make decisions every day regarding the optimal time to place a tracheostomy
but may not have the opportunity to follow the complete process of downsizing
and decannulation. Nurses routinely do tracheostomy care but may not realize
its significance in preventing complications. Respiratory therapists are experts
in managing the ventilator but may not be comfortable with other aspects of
care such as vocalization. In this book, we provide the fine details of the daily
care of patients with tracheostomies to help health care practitioners make
appropriate decisions and educate their patients.
Some medical centers have the benefit of a tracheostomy specialist to manage these patients, but it frequently falls to junior residents or others who are
often unaware of the available options and necessary precautions. We hope the
reader will come to appreciate the importance of this work as we describe in detail the art and science of caring for the patient with a tracheostomy. The book
spans the entire spectrum of care—from surgical placement, to choices and fitting of tubes, to restoration of voice, and, finally, to rehabilitation and recovery.
Because care of the tracheostomy patient involves many disciplines, chapter
authors have been chosen to share their unique perspectives and expertise.
We are certain the reader will find this book a useful clinical reference
and refer to it again and again. We invite comments, questions, and alternative approaches and techniques to trachs@yahoo.com, or visit our Web site at
www.TrachResource.com. Perhaps a future edition can include any omissions.
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Acknowledgments
The editors thank the many people who contributed to this work, including the
chapter authors; the editorial assistance of Allan Graubard, Brian O’Connor,
and colleagues at Springer; Mary Zemaitis and the team of medical illustrators
at Publication Services, Inc., who brought life to our words; the copy editors at
Apex CoVantage; the tracheostomy manufacturers for providing photographs
and information about their products; and Alberto de Hoyos for his bronchoscopic images of a percutaneous dilatational tracheotomy (in chapter 2).
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Tracheostomies
The Complete Guide
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Functional
Anatomy of the
Airway
M. Sherif Afi fi
1
Normal air passages start from the nose and end at the bronchioles of the lung.
They are vital to the delivery and modification of respiratory gas to and from
the alveoli, which are the center of gas exchange. For descriptive purposes, the
airway is divided into the upper airway, which includes the nose, mouth, pharynx, and larynx, and the lower airway, which includes the trachea, bronchi, and
the subdivisions of the bronchi. Each of these parts has its own independent
structural constitution, vascular supply, and nerve supply, all of which serve
to facilitate different and coordinated functions. The functions of the airway
include olfaction, deglutition (swallowing), phonation, and, of course, gas exchange. Any interruption to the normal anatomy of the constituents of the airway results in altered function of its various organs. As such, this chapter will
review the anatomical landmarks of the upper and lower airways, identify the
airway’s vascular and nerve supplies, and review the function of its various
parts. A comparison of changes in the airway from infancy to adulthood will
also be provided.
1