The patient us a 65 year-old man who has been in the MICU for 14 days with acute respiratory distress syndrome (ARDS). He had a percutaneous tracheostomy performed 2 days ago and he continues to require mechanical ventilatory support. You are called to the bedside by the ICU nurse because the high pressure alarm is going off on the ventilator and the patient is becoming hypoxic. The nurse states that this happened immediately after completion of a portable chest x-ray. The patient will initially be in respiratory distress, and will develop progressive hemodynamic instability and worsening hypoxia. Learner will assess the patient and should diagnose and manage tracheostomy occlusion and tension pneumothorax.

Learning Objectives

– Determine why a tracheostomy was performed, when it was performed, and the type of tracheostomy tube in place.

– Realize that the tracheostomy tube has an inner cannula and diagnose inner cannula obstruction.

– Recognize complications associated with ventilation through a partially obstructed inner cannula including hypoventilation, hypoxia, autoPEEP, and tension pneumothorax.

– Demonstrate appropriate management of tracheostomy occlusion and tension pneumothorax.