Endotracheal Intubation

 

Endotracheal intubation is the placement of a tube into the trachea (windpipe) in order to maintain an open airway in patients who are unconscious or unable to breathe on their own. Oxygen, anesthetics, or other gaseous medications can be delivered through the tube.

INDICATIONS
Specially, Endotracheal intubation is used for the following conditions ::
1. Respiratory arrest
2. Respiratory failure
3. airway obstruction
4. need for prolonged ventilatory support
5. Class III or IV hemorrhage with poor perfusion
6. severe flail chest or pulmonary contusion
7. multiple trauma, head injury and abnormal mental status

8. inhalation injury with erythema/edema of the vocal cords

9. protection from aspiration

CONTRAINDICATIONS
1. Unskilled operator.
2. Awake patient, jaw clenching.

TECHNIQUE
1. Pre-oxygenate with 100% non-rebreather or bag-valve mask and position patient in the ‘sniffing position’ with neck flexed and head extended on a pillow.
2. Remove poorly fitting dentures and suction oropharynx.
3. Standing at the patient’s head, hold the laryngoscope in the left hand and gently insert the laryngoscope blade over the right side of the tongue.
4. Advance the curved blade of the laryngoscope until the tip of the blade sits within the vallecula. Lift the blade forwards and upwards (taking care not to use the upper teeth as a fulcrum) to visualize the vocal cords.
5. Use the BURP (backward, upward, rightward pressure) manoeuvre on the thyroid cartilage as necessary to improve the view of the vocal cords.
6. Pass the endotracheal tube (size 8.5–9.5 mm internal diameter in adult males, and a 7.5–8.5 mm diameter in adult females) through the cords under direct vision, to a distance of 20–22 cm at the lips.
(i) Insert an introducer first to ‘stiffen’ the tube to facilitate placement.
7. Inflate the cuff, connect the oxygen supply, and check correct position of the tube by exhaled carbon dioxide detection, and by observing tube fogging, bilateral chest expansion and auscultation. Tie the tube in place.
8. Ventilate the lungs at 10 breaths/min.

COMPLICATIONS
1. Failure to intubate, with hypoxia.
2. Misplaced tube, e.g. oesophagus, or right main bronchus.
3. Airway trauma.
4. Aspiration.
5. Raised intracranial pressure.