It is believed that some family members of patients have experienced this:
The doctor will inform the patient when he or she is seriously ill.
A tracheostomy will be performed.
What is a tracheostomy?
Why is a tracheostomy performed?
Can I recover after a tracheostomy?
*How does the department make the patient's recovery faster?
The Second People's Hospital of Foshan City.
Here are the answers.
What is a tracheostomy?
Tracheostomy is a routine first-aid technique for critically ill patients by incising the patient's cervical trachea and inserting it into a cannula to solve the patient's airway obstruction, respiratory muscle weakness, sputum drainage and other problems.
Compared with endotracheal intubation, tracheostomy has the advantages of reducing sinusitis and throat injury, facilitating oropharyngeal hygiene, increasing patient comfort and communication, facilitating nursing operations, preserving swallowing function, closing of the vocal cords, and ease of replacement. However, long-term indwelling tracheostomy cannula can easily cause many complications such as infection, bleeding, airway stenosis, and tracheoesophageal fistula. Therefore, early intervention and early removal of the tracheal cannula are of great significance for the clinical outcome of patients.
Common *** method.
Tracheostomy patients can benefit from a number of ways to facilitate the recovery of body function. After positive activity, most patients can remove the cannula, resume independent oral feeding, pronunciation, participate in social activities, and live a dignified life. Common *** means are as follows:
1. Respiratory muscle function training and cough ability training.
Expiratory Resistance Training:
The tracheostomy cannula is connected to the expiratory resistance device, or the air in the balloon is withdrawn after the tube is blocked, and the expiratory resistance device is held in the mouth to overcome the expiratory resistance training. Gradually increase expiratory resistance, depending on the patient's condition. Prescription example: expiratory resistance 25 30 cmH2O, 5 10 min times, 3 4 times a day.
Inspiratory Resistance Training:
The tracheostomy cannula is connected to the inspiratory resistance device, or the air in the balloon is withdrawn after the tube is blocked, and the inspiratory resistance device is included in the mouth, and the inspiratory resistance is gradually improved, or a certain weight is placed in the patient's abdomen to let the patient overcome the abdominal resistance when inhaling, and the amount of exercise is determined according to the patient's condition. Prescription example: inspiratory resistance 25 to 30 cmH2O (or abdominal placement 2.)5~5.0 kg weight), 5 10 min times, 3 4 times d.
Cough training: After the tube is blocked, the air in the air bag is withdrawn, and the patient is asked to inhale deeply and then cough. Prescription example: 5 10 min times, 3 4 times a day.
Effective percussion expectoration method.
When percussion, put the five fingers together and put the palm together in a cup-shaped, use the wrist joint force, from bottom to top, from both sides to ** rhythmically percussion repeatedly on the back, or use the physical and mechanical vibration expectoration machine to percussion. Percussion should be performed 2-3 times a day for 5-10 minutes 2-3 times a day before or after a meal, depending on the patient's specific situation. If the sputum is viscous, it can be inhaled first and then photographed.
Extracorporeal diaphragm pacing** technique.
Extracorporeal diaphragm pacing technology is a new method of passive breathing, which is simple, safe and non-invasive, which can help patients improve diaphragm function, reduce dyspnea, improve atelectasis, and assist in deoxygenation extubation.
2. Swallowing function training.
Swallowing function training includes coordination training and active and passive control training of mouth, pharynx, tongue, larynx and other muscle groups. Common swallowing training methods are as follows:
1. Active exercise method:
Conscious patients can promote the patient's chewing or swallowing muscle groups** and coordination by guiding the patient to do lip, tongue, and cheek movements, including lip movement, buccal muscle movement, tongue or soft palate training, jaw movement and chewing training, tongue movement training, throat cold stimulation, oral sensory training, active swallowing action, etc.
2. Passive training method:
Swallowing movements are induced by electrical stimulation, magnetic wave stimulation, etc.
3. Feeding training:
This is a step-by-step approach to training the patient directly to eat. The training content includes the position of the food during eating, the position of the food intake, the nature of the food (size, structure, temperature and taste, etc.) and the eating environment.
4. Auxiliary training:
This is the posture and method used to swallow. Swallowing is usually made safe by changing the path of food and using specific swallowing methods, such as lateral swallowing, empty swallowing and alternating swallowing, and Mendelsohn maneuver.
3. Speech function training.
There are many ways to allow airflow through the vocal cords of a tracheostomy patient, one is to withdraw the air from the balloon so that the airflow can reach the vocal cords through the cannula-tracheal space: when the patient is not removed from the ventilator, a passy-muir speaking valve can be added to the circuit, and when the valve is closed at the end of inspiration, the airflow flows upwards through the vocal cords when the patient exhales, and vocalizations can be madeWhen the ventilator can be removed, a one-way speaking valve is attached directly to the tracheostomy, and the valve closes when exhaled, allowing the patient to vocalize. Another method is to inject oxygen or air for 1 5 l min through a drain tube on the balloon without pumping out the air inside the balloon, through which the patient makes vocalizations.
During speech function training, the tracheostomy is closed during expiration, so the patient's breathing should be closely observed during the training to avoid suffocation due to the obstruction of the upper airway, and a one-way valve that can be ventilated when the expiratory pressure exceeds a certain threshold (eg, 20 cmH2O) can be used to avoid asphyxia.
Training prescription: 30 60 min training times, 2 3 times d.
4. Whole body muscle and sports endurance training.
Repeated expansion of the chest wall or lungs and changes in body position during whole-body exercise training are beneficial for the drainage of airway secretions, and increased exercise tolerance can also reduce the rate of extubation failure and promote respiratory disease**. There is no standard method of exercise for tracheostomy patients, and they can choose to sit up, stand, step on the bed, step in place, or even treadmill according to the condition or the actual situation of the patient. Depending on the patient's exercise tolerance, this can be done with oxygen or assisted ventilation. During exercise, pay attention to monitoring heart rate, respiratory rate, pulse oximetry and other indicators.
Training prescription: Lying position** exercises include 3 movements: stretching sit-ups, arch bridge exercises and aerial cycling, which can train limb muscles, back muscles and abdominal muscles, with 5 10 min training per action and 2 3 d.
5. Respiratory critical illness** process.
Long-term tracheostomy state.
It can cause respiratory and swallowing functions.
and a series of physiological and functional changes.
This brings with it a series of complications.
Seriously affects the quality of life of patients.
The critical care team of the Department of Foshan Second Hospital insists on using scientific methods to speed up the removal of the patient's tracheotomy cannula. Tube occlusion training is also a step that every tracheotomy patient must go through, which requires a high degree of cooperation from patients and their families.
Hopefully, patients with similar problems will be positive**.
Remove the tracheotomy as soon as possible.
Improve quality of life and confidence in life.