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Questions and Answers
What is the correct location to place the centimeter marking on the ET tube for adults?
What is the correct location to place the centimeter marking on the ET tube for adults?
What is the correct depth of ET tube placement?
What is the correct depth of ET tube placement?
How can you confirm the endotracheal tube placement?
How can you confirm the endotracheal tube placement?
What is a complication of intubation?
What is a complication of intubation?
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What is a complication of remained intubation?
What is a complication of remained intubation?
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What is a complication of extubation?
What is a complication of extubation?
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What is a complication of after extubation?
What is a complication of after extubation?
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What is the purpose of inflating the cuff?
What is the purpose of inflating the cuff?
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What is the purpose of verifying proper depth of ET tube placement with a chest radiograph?
What is the purpose of verifying proper depth of ET tube placement with a chest radiograph?
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What is a step in the intubation process?
What is a step in the intubation process?
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Study Notes
Introduction to ET Intubation
- ET intubation is a procedure in which an ET tube is placed inside the trachea through the mouth or nostrils.
- It is simpler than tracheotomy, a surgical procedure that creates an airway opening by cutting into the trachea.
- ET intubation is preferred as the initial means of establishing an artificial airway.
Indications for ET Intubation
- General indications: patient requires an artificial airway for a brief period (e.g., 10 days or less) and full recovery is expected.
- Relief of airway obstruction:
- Epiglottitis
- Facial burns and smoke inhalation
- Vocal cord edema
- Protection of the airway:
- Prevention of aspiration
- Absence of coordinated swallow
- Facilitation of suctioning:
- Excessive secretions
- Inadequate cough
- Support of ventilation:
- Ventilatory failure / respiratory arrest
- Chest trauma
- Postanesthesia recovery
- Hyperventilation to ↓ intracranial pressure
ET Tube Insertion
- An ET tube may be inserted orally (oral intubation) or nasally (nasal intubation) through the larynx into the trachea.
- Intubation through the mouth is the preferred method of establishing an artificial airway.
- Oral route provides quick access to the lungs in emergency situations and allows the passage of a larger ET tube than the nasal route.
Initial Intubation Procedure
- Prior to intubation, the patient must be assessed to rule out any potential contraindications.
- The degree of difficulty in intubation due to anatomical structures can be evaluated by using the Mallampati classification method:
- Class 1 (easiest)
- Class 2 (difficult)
- Class 3 (more difficult)
- Class 4 (most difficult)
Equipment Needed for ET Intubation
- Required equipment:
- Laryngoscope handle
- Blade
- ET tube
- 10-mL syringe
- Water-soluble lubricant
- Tape
- Stethoscope
- Optional supplies:
- Stylet
- Topical anesthetic
- Magill forceps
ETT Sizes Estimation
- Size refers to the internal diameter (ID) of the tube in millimeters (mm).
- ETT sizes for different age groups:
- Neonate (, 1000 grams): 2.5 mm ID
- Neonate (1000 to 2000 grams): 3.0 mm ID
- Neonate (2000 to 3000 grams): 3.5 mm ID
- Neonate (. 3000 grams): 4.0 mm ID
- Child (1 to 2 years): 4.5 mm ID
- Child (2 to 12 years): 4.5 + (age/4) mm ID
- Adult female: 7.0 or 7.5 mm ID
- Adult male: 7.5 or 8.0 mm ID
Length of ETT
- Length of ETT for different age groups:
- Neonates: 6 + weight (in cm)
- >2 years: age/2 + 12 (in cm)
- Adult:
- Male: 21-24 cm
- Female: 18-21 cm
Procedure for Oral Intubation
- Steps for oral intubation:
- Assemble and test supplies
- Lubricate the deflated cuff with a water-soluble lubricant
- Inform or explain the procedure to the patient
- Bag-mask ventilate and preoxygenate the patient with 100% oxygen
- Tilt the head back and place in the sniffing position
- Open the mouth, apply anesthetic spray
- Hold the laryngoscope handle and insert the blade into the right side of the opened mouth
- Slide the blade to the base of the tongue and sweep the blade to the left
- Maneuver the tip of the straight blade underneath the epiglottis
- Lift the handle and blade up anteriorly to displace the tongue and attached soft tissues
- Locate the epiglottis, larynx, and vocal cords
- Insert the ET tube through the vocal cords under direct vision
- Inflate the cuff and confirm endotracheal tube placement
- Verify proper depth of ET tube placement with a chest radiograph
Complications of ET Intubation
- Complications during intubation:
- Trauma to lip, tongue, or teeth
- Hypertension and tachycardia or arrhythmia
- Pulmonary aspiration
- Laryngospasm
- Bronchospasm
- Esophageal intubation
- Complications during remained intubation:
- Obstruction from kinking, secretion, or overinflation of the cuff
- Accidental extubation or endobronchial intubation
- Disconnection from the breathing circuit
- Pulmonary aspiration
- Complications during extubation:
- Laryngospasm
- Pulmonary aspiration
- Edema of the upper airway
- Complications after extubation:
- Sore throat
- Hoarseness
- Tracheal stenosis (Prolong intubation)
- Laryngeal granuloma
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Description
Learn about the ET intubation procedure, its indications, and how it compares to tracheotomy. Understand the importance of establishing an artificial airway.
