What does patent mean in reference to the trachea?

Understanding "Patent" in Reference to the Trachea

When referring to the trachea, "patent" means the airway is open, unobstructed, and allows free passage of air, which is essential for adequate oxygenation and ventilation. 1

Clinical Significance of Tracheal Patency

A patent trachea is fundamental to airway management and patient survival. When assessing a tracheostomy:

• Patency can be confirmed by passing a suction catheter via the tracheostomy, which should move easily into the trachea 1
• If the suction catheter passes easily, the tracheostomy tube is considered patent and the ABCDE assessment can continue 1
• If the catheter cannot pass, the tube is likely blocked or displaced 1

Common Causes of Impaired Tracheal Patency

Several factors can compromise tracheal patency:

• Mechanical obstruction:

  • Presence of caps, obturators, or speaking valves attached to tracheostomy tubes 1
  • Blockage of humidifying devices with secretions 1
  • Accumulation of secretions in the tube itself 1

• Tube-related issues:

  • Displacement of the tracheostomy tube 1
  • Blocked inner cannula 1
  • Cuff-related problems 1

Assessment of Tracheal Patency

When evaluating tracheal patency in a patient with a tracheostomy:

1. Remove any attachments (caps, speaking valves, humidifying devices) 1
2. Check and remove the inner tube if present, as this may resolve obstruction 1
3. Pass a suction catheter to:
   • Confirm patency along the entire length of the tube 1
   • Clear secretions if present 1
   • Avoid using stiff introducers like bougies which may create false passages 1

Management of Impaired Patency

If the trachea is found to be non-patent:

1. Deflate the cuff if present, which may allow airflow past a partially displaced tube 1
2. Remove the tracheostomy tube if deflating the cuff doesn't improve the situation 1
3. Apply oxygen to both the face and stoma 1
4. Establish emergency oxygenation via oro-nasal route, tracheostomy stoma, or both 1

Clinical Pitfalls to Avoid

• Never attempt vigorous ventilation through a potentially displaced tracheostomy tube, as this can cause surgical emphysema 1
• Always confirm patency with a suction catheter before attempting ventilation 1
• Avoid blind manipulation of the stoma without appropriate equipment and expertise 1
• Remember that a non-functioning tracheostomy in a deteriorating patient offers no benefit and has potential for harm 1

Maintaining tracheal patency is critical for patient survival, as obstruction can rapidly lead to hypoxia, cardiorespiratory arrest, and death if not promptly addressed.