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Care Study: A critical event in tracheostomy care

Albert Collis is an 80-year-old man who was admitted to the intensive care unit with an episode of acute pancreatitis, 6 weeks before a critical incident in his tracheostomy care. His pancreatitis was managed medically, with part of this treatment involving mechanical ventilation. Although the pancreatitis responded well to treatment, Albert developed a chest infection and proved difficult to wean from the ventilator. A tracheostomy was therefore performed 2 weeks after admission, both for Albert's comfort and to facilitate the weaning process. Albert's muscles had wasted considerably during his admission and his respiratory muscles were very weak. In the 4 weeks following his tracheostomy he had progressed slowly from pressure control mode to synchronised intermittent mandatory ventilation and pressure support, to pressure support only. He then went on to a continuous positive airway pressure circuit, and for the 2 days before the incident had been on a T-piece with a thermovent humidifier with 28% oxyge...