2. • The Endotracheal tube(Intratracheal tube or trachea catheter)
• Endotracheal intubation is the placement of ET tube inside the trachea
through the mouth or nostril.
3. Endotracheal Tube:
• Device that is inserted through the larynx into trachea to convey
gases and vapors to and from lungs.
4.
5.
6. Parts of ET tube:
• Bevel
• Murphy eye
• Curve of tube
• Markings on the tube
• Tube cuff
• Machine end
• Pilot balloon
7. Bevel:
• Should be facing towards left, as larynx is easy to
visualize.
• Bevel reduce the morbidity to nasal cavity during
nasotracheal intubation.
•Murphy eye:
• Advantage: In case of bevel blockage it provides a secondary
port for gas movement in and out of tube.
• Disadvantage: Sometimes secretions accumulate in the
murphy eye.
8. •Curve of tube:
• It makes intubation easier.
• A typical tracheal tube is shaped like an arc of a circle
with a radius of curvature of 140 +/- 20mm.
•Markings on the tube:
• Tracheal tube size (Internal diameter) is either in
millimetres or French scale size.
• A longitudinal line of radio opaque material runs
throughtout the length of tube,used for confirmation
of tube placement from an Xray
9.
10. •Tube cuff:
• Low volume high pressure cuff
• High volume low pressure cuff
11. • Advantage:
• Better protection against aspiration.
• Lower incidence of sore throat.
• Less expensive .
• Disadvantage:
• Ischemic damage to the tracheal wall
mucosa.
• LOW VOLUME HIGH PRESSURE
CUFF
• HIGH VOLUME LOW PRESSURE
CUFF
• Advantage:
• Lesser cuff related complication
following prolonged intubation.
• Disadvantage:
• More difficult to insert as the cuff
may obscure the view of larynx.
• Increased incidence of sore throat.
• More chance of aspiration.
12. Pilot balloon:
• A pilot Balloon with a one way valve allows for the inflation of the
cuff and an assessment of cuff pressure.
• Cuff pressure should be less than 25cm H2O.
• Excessive cuff pressure may result in tracheal mucosa injury,vocal
cord dysfunction from recurrent laryngeal nerve palsy and sore
throat.
13. Laryngoscope
• It is used to displace the tongue ,soft tissues and visualize
the larynx,vocal cord during intubation.
• Parts of laryngoscope :Blade and handle.
• Blade: spatula ,flange and light source.
• Laryngoscope is held in left hand near junction between
handle and blade.
• For infants- blade 0-1,For 2-8 years-blade 2 ,For 10-Adult-
blade 3,For large adults-blade 4
14.
15. Types of laryngoscope -Blades
Macintosh blade:Adult
• Curved blade
Miller blade: Children
• Used in patients with short
thyromental distance or
prominent incisors.
17. Pre intubation assessment and signs of
difficult airway:
• Mallampatti classification(MPG)- method to evaluate the
degree of difficulty in intubation.
18. Other signs of difficult airway:
1. Large tongue
2. Short, thick neck
3. Reduced mouth opening
4. Limited head extension
5. Dental overbite
6. Long upper incisors
7. Inability to protrude mandible
8. Short thyromental distance
9. MPG classification 3 or 4
20. INDICATION:
• Surgical indications:
patients for surgery with Full stomach.
IPPV.
All head&neck surgeries With compromised airways.
Surgery for a long time also nonsupine position.
Abdominal,Thoracic, neurosurgical procedures.
21. • Nonsurgical indications:
CPR
Conscious or semiconscious patients unable to protect the
airway.
inadequate or gasping respiration.
Tracheobronchial toilet for retained secretions.
23. Orotracheal intubation:
• ‘Morning air Sniffing ‘position(chevalier jackson Position).
• Oral, pharyngeal&laryngeal axis in one line.
• Holding of laryngoscope with left hand.
24.
25.
26. Advantage:
• Quick and easy.
• Wider and shorter tube.
• Less Traumatic.
• Lower risk of bleeding .
• Reduced risk of tube kinking.
• Less airflow resistance
27. Disadvantages:
• Oropharyngeal complications.
• Not Well tolerated by conscious patient.
• Biting of tube.
• Self extubation.
• Gagging,coughing,salivation and irritation can be induced with intact
airway reflexes.
• Mucosal irritation and ulceration of mouth.
35. Indications:
• Where an Oral tube Would obstruct the view of the surgeon.
• Surgery for fracture mandible.
• Temporomandibular Joint ankylosis.
• Intraoral pathology.
• Neck injury or cervical spine disease.
37. Advantages:
• Securing the tube easier
• Less of cervical spine movement hence useful in trauma cases
• No biting of tube
• Well tolerated by conscious patient.
• Decreased gagging.
• Less salivation.
• Better tube fixation.
38. Disadvantages:
• Usually takes Longer time
• Chances of Severe bleeding.
• High incidence of Bacteremia,Sinusitis &otitis.
• Increased airflow resistance.
• Difficult suctioning.
39. Blind Nasal Intubation:
• It is done by advancing ET tube slowly during spontaneous inspiratory
efforts by listening for air movement through the ET tube
• Proper depth of nasal ET tube is guided by the distance markings
(e.g 26 cm for adult females&28cm for adult males) on the ET tube at
the lips or incisors
40. Confirmation of correct placement of tube:
Clinical confirmation(Primary):
• Direct visualization
• Moisture of exhaled gases in the lumen of tube
• Palpation of tube
• Bilateral chest movement
• Bilateral air entry On auscultation
• Movement of reservoir bag
42. Signs of Endotracheal intubation:
• Rising SpO2
• Presence of B/L Breath sounds
• Airflow
• Pulse oximeter
• Moisture or condensation
• Detection of CO2
43. Signs of Esophageal Intubation:
• Oxygen desaturation
• Deteriorating vital signs
• Cyanosis
• Stomach distention and Aspiration
44. Rapid sequence Intubation:
• RSI is done using an endotracheal tube under controlled settings to
optimize the intubation conditions to protect the airway against
Aspiration and facilitate ventilation and oxygenation
Indications:
• Airway obstruction
• Severe Brain injury
• Abnormal respiratory frequency
• Haemodynamic instability
45.
46.
47. Complications of Intubation:
During intubation:
• Trauma to teeth and soft tissues.
• Hypoxia due to prolonged intubation attempt.
• Esophageal Intubation
• Bronchial intubation
• Trachea tube obstruction
• Vomitting and Aspiration.
• Arrhythmias
• Bradycardia due to vagal stimulation.
48. While intubated:
• Obstruction by secretion.
• Pneumonia and atelectasis.
• Kinking of ET tube.
• Mucosal injuries.
• Laryngeal damage.
• Pressure sores around ET tube.
• Sinusitis (nasal intubation).
