Year: 2024
Type: article
Study design: Case Report
Abstract: The ScenarioAn elderly gentleman with a history of a supraglottic mass causing stridor was urgently admitted for awake tracheostomy placement, laryngoscopy with biopsies, and expedited oncologic evaluation.His inpatient stay involved tracheostomy management, further oncologic workup for laryngeal squamous cell carcinoma, and pain management.Initially, he opted for full code/full care.However, in further discussions, he expressed the desire for prioritization of pain management and avoidance of a medically or artificially prolonged disease course.He firmly chose to be do-notresuscitate/do-not-intubate (DNR/DNI) but was open to pain-relieving and dyspnea-relieving treatments.The option of receiving positive pressure through his stoma in place of intubation was not discussed within the goals of care conversation.He was transitioned on Postoperative Day 5 to an uncuffed tracheostomy tube for improved voicing.On Postoperative Day 10, the patient's work of breathing increased, and his mental state changed abruptly.The medical team suspected hypoxia, potentially from aspiration, COPD exacerbation, or polypharmaceutical narcosis.They urgently decided to switch to a cuffed tracheostomy tube to offer positive pressure ventilation.The question arose as to whether this change conflicted with the patient's current DNI directive.Due to his mental status change, the patient was unable to communicate and his family, unacquainted with the nuances of cuffed and uncuffed tracheostomies, did not feel they could make an informed decision regarding the change.
Source: Otolaryngology
DOI: 10.1002/ohn.979
Authors: Zoë Fullerton, Monica Bodd, Susan McCammon, Brian Nuyen
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4402619296