Intubation & Ventilation Scenario 8

      
   

 

      
      A 73 year old male is discharged from the intensive care unit, following a three week admission for sepsis following a perforated appendix. He has been short of breath all evening. Now he is severely distressed and his chest is moving up and down in a seesaw manner.        
     


Patient intubated for Bronchial Toilet (removal of impacted secretions)

Solution

The combination of recent discharge from ICU, which indicates potentially a recent extubation, and paradoxical breathing, is strongly suggestive of upper or middle airway obstruction. The cause may be in the oropharynx (tongue or dentures obstructing breathing), the larynx (laryngeal edema or stenosis) or below the larynx. One thing to strongly consider is accumulation of secretions or inspissation of mucus, due to ineffective bronchial toilet (the patient probably has a very poor cough). This patient had a collapsed right lung on chest x-ray. He was intubated and a large mucus plug was removed from his right main bronchus.