Mechanical

Laryngectomy patient with respiratory distress

Before / During / After / Pitfalls

Before

  • Recognize total laryngectomy: no connection between mouth/nose and lungs.
  • Oxygenate/ventilate through stoma; mouth/nose oxygen will not ventilate.
  • Bring laryngectomy/trach supplies and call ENT/RT.

During

  • Remove stoma cover/HME, suction stoma, ventilate with pediatric mask or adapter over stoma.
  • Do not attempt oral intubation for a total laryngectomy.
  • Place cuffed tube in stoma if needed and trained/appropriate.

After

  • Confirm with EtCO2 at stoma.
  • Secure airway device and communicate laryngectomy status.
  • Treat underlying obstruction/infection/plug.

Pitfalls

  • Trying to BVM the face only.
  • Confusing trach with laryngectomy.
  • No stoma EtCO2 confirmation.

Educational resource only. Use institutional protocols, local policy, and bedside clinical judgment.