With regards to this TRALI patient post tracheostomy and trache-collar trial in progress for > 12hrs,
a) how do you think the patient is doing?
b) what do you think the physician thinks how this patient is faring?
c) how do you think the physician decided to manage this patient?
d) how would you handle this patient in the next 12hrs?
The Edi vs time scalar is demonstrated above.
This is the patient who continued on a trache collar trial for approximately 18 hours.
The patient had stable vital signs with a HR=80-84, RRspont=18-22 and SpO2~95%.
The patient was sleeping very comfortablly and without signs of respiratory distress (no costal retractions and no nasal flaring).
The CXR and ABG are shown above.
This is the patient the day after tracheostomy. Note the lung fields are expanded even moreso due to having been “rested” on SIMV-VCV during the night.
This is the patient with the trache in-situ and the NAVA cath in-situ. Note that the lung fields are well expanded while the trache was being placed (the patient was placed on full ventilatory support).
This was a TRALI (transfusion related acute lung injury) patient who was deemed a FTW (failure to wean). At the end of two weeks, the patient agreed to be trached and to have a NAVA catheter inserted.