This document discusses the history and indications/complications of tracheal intubation and ventilation. It outlines that intubation was first described in the late 18th century and developed through the 19th-20th centuries. The main indications for intubation are anesthesia, CPR, and respiratory failure. Complications can occur during and after intubation, including trauma, infection, and nerve damage. Ventilation is indicated for respiratory failure, anesthesia, and surgery. Complications of ventilation include cardiovascular, respiratory, and renal issues as well as risks from intubation such as barotrauma.

1. TRACHEAL INTUBATION AND
VENTILATION: THE INDICATIONS AND
COMPLICATIONS
DR A SAFA 2002

2. A BRIEF HISTORY OF
INTUBATION
• 1788 KITE DESCRIBED ORAL/NASAL INTUBATION FOR
RESUSCITATION AND LARYNGEAL OBSTRUCTION
• 1880 MACEWEN ADVOCATED INTUBATION RATHER THAN
TRACHEOSTOMY IN HEAD+NECK SURGERY
• 1885 O’DWYER DESCRIBED INTUBATING TUBE
• 1895-1915 KIRSTEIN, KILLIAN, JACKSON LARYNGOSCOPY
PIONEERED
• POST WWI MAGILL+ ROWBOTHAM DEVELOPED MODERN
ENDOTRACHEAL ANAESTHESIA AND BLIND NASAL
INTUBATION

3. A BRIEF HISTORY OF
VENTILATION
• 1543 VESALIUS IN A PIG VIA TRACHEOSTOMY
• 1667 HOOKE USING BELLOWS VIA TRACHEOTOMY
IN A DOG
• INITIALLY USED FOR CPR
• 1820’S WATERTON ANIMALS+ CURARE
• LATE1800’S/EARLY1900’S USED IN ANAESTHESIA
• 1940’S NEUROMUSCULAR BLOCKERS INTRODUCED AND
USE MORE WIDESPREAD
• 1952 DANISH POLIO EPIDEMIC SAW USE INCREASED DUE
TO RESPIRATORY FAILURE

4. TRACHEL INTUBATION
INDICATIONS
• ANAESTHETIC
– RESTRICTED ACCESS
– PROTECTION OF
TRACHEA FROM SOILING
– TO SECURE AIRWAY
– WHEN MUSCLE
RELAXATION
REQUIRED
– IF IPPV REQUIRED
• NON-ANAESTHETIC
– CPR
– IF IPPV REQUIRED
– TO SECURE/PROTECT
AIRWAY
– ALLOW ASPIRATION OF
SPUTUM/SECRETIONS

5. TRACHEAL INTUBATION
COMPLICATIONS 1
• DURING INTUBATION
– TRAUMA
• EYES, NECK, JAW, TEETH, LIPS, NASAL MUCOSA, MOUTH,TONGUE,
PHARYNX, LARYNX, LARYNGEAL NERVES, TRACHEA
• RESULTING IN
– INFECTION
– BLEEDING
– SURGICAL EMPHYSEMA
– HYPERTENSIVE RESPONSE
• MAY RAISE ICP
• LARYNGOSCOPY ALONE WILL CAUSE THIS
– ARRHYTHMIAS
– LARYNGOSPASM
– BRONCHOSPASM

6. TRACHEAL INTUBATION
COMPLICATIONS 2
– BREATH HOLDING
– ASPIRATION OF GASTRIC CONTENTS
– MISPLACED TUBE
– FAILED INTUBATION
– BACTERAEMIA

7. TRACHEAL INTUBATION
COMPLICATIONS 3
• AFTER INTUBATION
– DISPLACEMENT OF TUBE
• EXTUBATION
• ENDOBRONCHIAL INTUBATION
– DISCONNECTION FROM FRESH GAS SUPPLY
– AIRWAY OBSTRUCTION
– CUFF
– LASER IGNITING TUBE
– COMPLICATIONS OF EXTUBATION

8. TRACHEAL INTUBATION
COMPLICATIONS 4
• LATE COMPLICATIONS
– CORD ULCERATION AND GRANULOMA
– SUPERIOR/ RECURRENT LARYNGEAL NERVE DAMAGE
– TRACHEAL STENOSIS
– NASAL/ORAL ULCERATION
– SINUSITIS

9. VENTILATION 1
• INDICATIONS
– ICU
• HEAD INJURY
• RESP. FAILURE
• OTHERS
– COMA, POST CPR
– ANAESTHETIC
• NEUROMUSCULAR BLOCKADE REQUIRED
• THORACIC SURGERY
• INADEQUATE VENTILATION
• TO CONTROL PaCO2
• TO REDUCE INHALATIONAL AGENT REQUIREMENTS
• TO ENSURE ADEQUATE AIR ENTRY

10. VENTILATION 2
• COMPLICATIONS
– CARDIOVASCULAR
• REDUCED VENOUS RETURN
• REDUCED CARDIAC OUTPUT
• REDUCED BP (ESP AUTONOMIC NEUROP. OR HYPOVOL.)
– INCREASED PULMONARY VASCULAR RESISTANCE
– REDUCED LV COMPLIANCE AND FILLING (ESP IF PEEP)
– RAISED MEASURED CVP
– REDUCED VENOUS DRAINAGE FROM HEAD AND NECK
– INCREASE ICP

11. VENTILATION 3
– RESPIRATORY
• INTRAPLEURAL PRESSURE CHANGE
• FALL IN LUNG COMPLIANCEAND FRC
• ATALECTASIS LEADING TO INCREASED ALVEOLAR-ARTERIAL O2
DIFF AND DEAD SPACE
– RENAL
– ILEUS
– RISKS OF TRACHEAL INTUBATION
– BAROTRAUMA
– UNDETECTED DISCONNECTION