Which action would support airway management in an ARDS patient with a tracheostomy?

• A. Encouraging a fluid intake of 3 L daily
• B. Suctioning via the tracheostomy every hour
• C. Applying an occlusive dressing over the stoma
• D. Cleaning the stoma with peroxide using cotton balls

Answer: (A)

Maintaining the airway in an ARDS patient with a tracheostomy hinges on keeping secretions thin and easy to clear. Encouraging adequate hydration helps reduce mucus viscosity, enhancing mucociliary clearance and lowering the risk of mucus plugging that can compromise ventilation.

Frequent suctioning, especially every hour, can irritate the airway, cause desaturation, and may not address the underlying issue of thick secretions; it’s not a substitute for proper hydration and humidification. Putting an occlusive dressing over the stoma would block airflow through the tracheostomy, impeding ventilation and posing a serious risk. Cleaning the stoma with peroxide is not advised, as peroxide can irritate or damage mucosa; saline or appropriate sterile cleaning methods are preferred.