In this scenario, the learner is called to the bedside of a 65-year-old man by a MICU nurse due to hypoxia and low pressure alarm on the ventilator. The patient has a prolonged recovery from ARDS and requires a continual mechanical ventilatory support. He also underwent percutaneous tracheostomy insertion 10 days ago. The learner should examine the patient and ventilator to determine that there is a cuff leak. They must then try to inflate the cuff, though it will be unsuccessful. For a successful scenario, the learner must safely remove and replace the tracheostomy to stabilize the patient.

Learning Objectives

– Recognize the signs and symptoms of a tracheostomy cuff leak
– Determine why a tracheostomy was performed, when it was inserted, and if the patient can be intubated from above
– Safely remove and replace a tracheostomy