Artificial airway types

2.  PHARYNGEAL
 Nasopharyngeal
 Oropharyngeal
 TRACHEAL
 Nasotracheal
 Orotracheal
 Tracheostomy

3.  To guarantee patency of airway
 To improve airway protection
 To allow positive pressure ventilation
 To facilitate suctioning

4. Nasopharyngeal airway

5.  It is made of soft rubber, silicone or
polyvinyl chloride (PVC)
 Part ; flange at the proximal end and with a
beveled distal end
 Size; distance from the nares to angle of
mandible

7. Indication
 Indicated when oropharyngeal airways are
contraindicated
 Advantage of the nasal airways over the oral
airways is that it is better tolerated by
conscious and semi-conscious patient.

8. Contraindication
 Nasal trauma
 Basilar Skull fractures
 Deformities of the nose
 Coagulation disorders

9. Hazards
 Sinusitis
 Otitis media
 Gastric insufflation (if the airway is too long)
 Intubation of meninges (in case of head or facial
trauma)
 Occlusion of the airway by secretion
 Tissue necrosis
 Bleeding

10. Oropharyngeal airway

11. Gudeal
 Berman

16.  Holds the tongue away from pharyngeal wall
 Bite block after intubation
 Size; lip to the angle of mandible
 Inserted only in deep comatose patients

17.  Berman airway has an J –beam construction
with a channel along each side
 Guedel airway is open down the middle
 Size range from 000 to 6 ( premature to
adult)

18. Indication
 Unconscious patients

19. Contraindication
 Oropharyngeal trauma
 Conscious or semiconscious patients ---------
induce (vomiting and aspiration )

20. Hazards
 Oral trauma
 Pressure necrosis (if left in place too long)
 Gagging
 Vomiting
 Aspiration
 Airway obstruction ( with improper
insertion)

22. Use of Endotracheal tube
 To prevent airway obstruction
 To facilitate suctioning
 To provide mechanical ventilation
 To protect the lower airway from foreign
objects

23. Age Internal diameter Distance inserted at
lips
premature 2.5 10
New born 3 11
1- 6 months 3.5 11
6 – 12 months 4 12
2 years 4.5 13
4 5 14
6 5.5 15 – 16
8 6 16- 17
10 6.5 17- 18
12 7 18- 22
> 14 female 7 20 – 24 (21)
> 14 male 8 20 – 24 (23)

24. Size of tracheal tube(mm) x 3
2
Rule of thumb ; outer diameter of
the suction catheter should be ½ or < ½ the
inner diameter of tracheal tube

25.  It is usually constructed of polyvinyl chloride
(PVC) or silicone
 The construction of Endotracheal is standard;---
----------------------
 Distal end is beveled and rounded to minimize
trauma on insertion
 Murphy eye ----------- ( allows passage of gas
through it if the end becomes occluded by secretion.
 A cuff------- is present distal end of the tube

26.  Pilot tube ------- (extends past proximal end
of the tube and terminate with a pilot balloon
and spring –loaded valve
 Radiopaque line that allows for ready
visualization of the tube on radiography
 Proximal end of the tube is fitted with a
standard 15 – mm adapter (universal adaptor)

27. Contraindication
 Generally not addressed, but two important
ones are
 complete obstruction of the upper airway
 Lack of person trained and experienced in
tracheal intubation

28. Complication
 Bronchospasm
 Laryngospasm
 Hypoxemia
 Esophageal intubation/gastric distention
 Rupture of trachea/cuff
 Aspiration (blood,tooth ,gastric contents)
 Airway obstruction
 Sore throat, dysphasia

29.  Paralysis of vocal cords
 Vocal cord adhesions
 Tracheal stenosis
 Laryngeal edema/ulceration
 Ulceration of lips, mouth, pharynx
 Tracheal bleeding

30.  Assemble and check equipment
 Position the patient
 Pre- oxygenate
 Insert laryngoscope
 Visualize and displace glottis
 Insert tube
 Assess tube position
 Secure and stabilize airway

31. Intubation

32. Equipment for oral and nasal
intubation
 Laryngoscope handles and blades
 Endotracheal tubes, assorted sizes
 Tape or commercial tube fixation device
 Magill forceps
 Syringe
 Stylet
 Suction
 Manual resuscitator/ oxygen
 Water-soluble lubricant
 Sedatives and paralyzing agents

33. Laryngoscope
 Two principal parts; handle and blade
 Two type of blade ;-------- straight and curved
 Straight blade ( Miller );------ directly lift the
epiglottis to allow visualization of the vocal cords
 Curved blade; (Macintosh)------- indirectly lift the
epiglottis

35.  Ascultation of chest and epigastrium
 Observation of chest movement
 Tube length (cms of teeth)
 Airway condensation
 Capnometry/ copnography
 Gastric contents

36.  Goals ;
 Relief of upper air way obstruction
 Long term mechanical ventilation
 Acute / chronic neuromuscular conditions
 Brain injury

37. Tracheostomy tube
 Advantages of Tracheostomy
 Suctioning is facilitated
 It is better tolerated by the conscious patient
 Fixation of tube is easier
 Eating and even speaking (with proper tube )

38.  Tracheostomy is used when Endotracheal
intubation is impossible (complete upper
airway obstruction )
 It is used when a long term airway is needed,
and it is usually considered after 10 to 14 days
of intubation

39.  Tracheostomy tubes made from a plastic,
such as PVC or silicone and also made of
silver or stainless steel.
 Several manufacturs also produce a
fenestrated tube (or window)

43. 

45. 

46.  It has four parts ;------------
 Inner cannula, outer cannula, obturator and cuff
 The inner cannula can be removed to clean
secretions and blood from interior surface without
removing the entire tube.
 The obturator prevents blood or mucus from
entering the tube as it is being inserted and provides
a smoothly tapered surface to facilitate introduction
of the tube into the airway.

47. Complication of Tracheostomy
 Hemorrhage
 Subcutaneous emphysema
 Obstruction
 Wound infection
 Recurrent laryngeal nerve damage
 Tracheal stenosis
 Dysphagia
 Tracheoesophageal fistula
 Subglottic edema
 Aspiration and atelectasis

48.  Increased patient mobility
 More secured airway
 Increased comfort
 Enchanced airway suctioning
 Early transfer and mobilization
 Improved oral hygiene and nutrition
 Enhances communication and phonation
 Reduced airway resistance

49.  Low volume
High pressure cuff
 High volume
Low pressure cuff
bad
good

50.  Optimal pressure ; 20 – 25 mm Hg
 Capillary perfusion pressure 25 -30 mm Hg
 Increased pressure --- ischemia and stenosis
 Decreased pressure --- microaspiration

51.  Remove inner cannula prior to humdification
and suctioning
 Wash inner cannula with saline and hydrogen
peroxide
 Wet gauze pads for continuous
humdification
 Home care