With technical advances & improved survival of criticlly ill patients delayed outcome of endotracheal intubation are getting evident.

1. Endotracheal Intubation & It’s
Complications
Dr Shrikant Phatak
Head of ENT Department
Choithram Hospital & Research Center
Indore

2. Endotracheal Intubation &It’s Complications
• Endotracheal intubation is done for general
anaesthesia, assisted ventilation ,to secure the air
way & for cardio pulmonary resuscitation.
• With the improved critical care &survival
complications of intubation are getting evident.
• The complications can be prevented by proper care
of the tube, selecting proper size of the tube &
ensuring proper position of the tube in the air way.

3. Air Way An ENT Perspective
Adult larynx is cylindrical so the narrowest part of
the upper airway is the Glottis. In children it is
funnel shaped the narrowest part is at the cricoid
cartilage. These are the vulnerable areas in a
forceful intubation. Laryngeal edema occurs much
more rapidly in pediatric age group

4. Standard protocol
For tube size &
depth
1. The exact size of the
endotracheal tube to
be put should be
tailored according to
the individual patient
2. . The inter arytenoid
distance is the
deciding factor.
3. As the tube rests in
posterior glottis the
chances of trauma are
maximum in the Inter
arytenoid area

5. Endotracheal Intubation & It’s Complications
The complications can be
1 Immediate
2 Delayed
Here we are discussing the delayed
complications of prolonged intubation.
If proper care is not taken even patients are seen to have
stridor &respiratory distress even after a short intubation for 36
hours

6. Endotracheal Intubation &It’s Complications
• If ventilatory support is needed for more than
5 to7 days Tracheostomy is required.
• Proper sedation level post intubation prevents
tracheal wall injury by the tube.
• Any voice change or breathing difficulty post
extubation needs upper airway assessment by
ENT surgeon & X-Ray Soft tissue neck lateral
view.

7. Endotracheal Intubation &It’s Complications
Lie of the tube in the tracheal
lumen Tube in Right bronchus

8. Position of the
Tube & Cuff
A high placed tube
with the inflated cuff
in glottis or
immediately below the
cords in sub glottis this
can cause in
Supraglottic & Glottic
damage .

9. Lye Of the Tube in the
lumen of the Trachea
The lie of the tube in the
lumen of The Trachea is
influenced by the position of
the connecting tubing in the
circuit. Faulty position of the
connections in the circuit can
change the tilt of tube in the
tracheal lumen & cause
trauma by the Beveled tip
which in the long term causes
stenosis

10. Endotracheal Intubation & It’s Complications
• Position of the tube if tube is not
parallel in the lumen Tube tip can
cause mucosal Trauma
A curved Tracheostomy tube tip can
cause mucosal trauma

11. Sequel of prolong Intubation

12. Endotracheal Intubation & It’s Complications
• Normal Inter arytenoid
Distance decides the tube size
• Inter arytenoid Distance in adult
with infantile Epiglottis will
accommodate smaller tube

13. Endotracheal Intubation & It’s Complications
Inter arytenoid area ET Tube
Pressure Point
Trauma to the arytenoids heals
by fibrosis leads to Stenosis

14. Endotracheal Intubation &It’s Complications
Ulceration Angle of Mouth Position Tube In Right Bronchus

15. Endotracheal Intubation & It’s Complications
Intubation Granuloma

16. Endotracheal Intubation & It’s Complications
Cord Injury Posterior Supraglottic Web

17. Endotracheal Intubation &It’s Complications
Supraglottic Stenosis X-Ray Subglottic Web

18. Endotracheal Intubation &It’s Complications
Subglottic Stenosis Tracheal Narrowing

19. Endotracheal Intubation & It’s Complications
Supra stomal Stenosis Supra stomal Stenosis

20. Endotracheal Intubation & It’s Complications
Grade 4 Subglottic Stenosis Subglottic Granulation & Web

21. Disclaimer
• The information contained in the presentation is based on the personal
experience and cases collected at Choithram Hospital Indore over the last
20 years.
• It is intended for the use of Medical students ENT& anesthesia post
graduates & intensivists.
• The views expressed are purely on personal opinion. viewers can make
their own opinion. For any confusion please contact sole author.
• Everybody is allowed to copy or download the material best suited to him.
I am not responsible for any controversies arising out of the presentation.
• For any suggestions or corrections you may please contact
phatak_shrikant@yahoo.in

22. Endotracheal Intubation & It’s Complications
Thank you