The act of connecting most people to ventilator machines requires that a plastic tube be placed in the upper airway (endotracheal tube). The presence of the throat tube places the patient at high risk for internal pressure ulceration of the mouth and throat and for lung infection. The prevention of this complication requires meticulous nursing care. The tube has an internal balloon, which, when inflated, anchors the device in the windpipe (trachea). This causes pressure and must be relieved every eight hours for a few minutes. The nurse has to be careful not to allow the tube to dislodge during this procedure. There is also pressure against the inside of the mouth and the tongue. Thus the nurse has to reposition the outer portion of the tube every eight hours.

Additionally, when a person has to remain connected to a breathing tube for a long period or when there is swelling in the upper windpipe, a surgeon makes a hole in the throat (tracheostomy) and connects the breathing tube to the respirator through this opening.

Preventing lung infection is a more difficult task. The human airway has a number of natural safeguards to prevent lung infection. The first line of defense is the structure of the throat that traps dust particles and droplets. This is a highly effective barrier to infection. The endotracheal or tracheostomy tube bypasses this structure and allows dust and contaminated droplets to enter directly into the lower airways. This brings us to a discussion about sputum. I know that this particular subject is disgusting, but it is the only way for you to know if your loved one is suffering from a potential lethal lung infection, so you will need to get past your initial revulsion. All too often, nurses will go about their business and not notice the signs of respiratory system deterioration. Therefore, if you have a family member or close friend on a respirator in the lCU, you will need to be able to monitor changes in the color and consistency of the lung secretions. Then you will know whether to alert the nurses and doctors that something looks wrong and demand to know what they are going to do about it. You will be able to see the sputum because the exhaled air expels it into the clear plastic tubing that attaches the patient's airway to the breathing machine. This table explains what to look for and what to do about it.

Although infection is not always avoidable, nurses are required to perform certain services working toward a goal of keeping the airway free of infection. This requires suctioning as needed with lavage (squirting three milliliters of saline into the airway tube for cleansing the airway and loosening the dried secretions). If the patient sounds congested with raspy breathing noises, get the nurse immediately and demand that he or she suction the patient. There is no substitute for aggressive meticulous nursing care.

Moreover, with regard to tracheotomies, all the guidelines pertaining to breathing tubes apply, with additional concern for the site at the front of the neck. The dressing must be clean and dry at all times. If it looks soiled, somebody did not do his or her job, and you will need to complain about it.

How to Spot Respiratory Problems

Color Consistency Odor Comment

Clear Thin None Within normal limits

Clear Thick None Within normal limits

White Thin None Within normal limits

White Thick None First sign of problem-might be due to dehydration

Yellow Thick None to slight Upper respiratory infection-get the nurse and find out what the treatment plan is

Yellow to green Thick Slight Infection is getting worse-the treatment plan is not working. Find out what they are doing about it

Cream colored Thick Moderate This is purulence (pus) coming from the lungs. Ask the doctor if there is an infectious disease consultant on the case. If not, make a demand for one

Coffee colored Thick and chunky Foul This is likely a dangerous deep lung infection with possible gangrene. Insist on a detailed explanation of the interventions