1. Artificial Airways
RC 275

2. Indications for an Artificial Airway
To facilitate mechanical ventilation
To protect the airway, eg, prevent aspiration
To facilitate suctioning
To relieve upper airway obstruction

3. Oropharyngeal Airways
Used to prevent tongue from occluding the airway

5. A conscious patient can not tolerate this airway!

7. Oropharyngeal Airway Sizes
00-6
Most adults take between 3 and 5
Correct size by measuring from corner of mouth to bottom of earlobe

8. Oropharyngeal Airway Insertion

9. Nasopharyngeal Airways
Prevent tongue from blocking airway
Tolerated by conscious or semi-conscious patient

10. Nasopahryngeal Airway Sizes
Are in French units
Measure from tip of nose to bottom of earlobe
Also base on diameter of patient’s nares

11. Nasopharyngeal Airway Insertion

12. Nasopharyngeal Airway Insertion (cont.)

13. The Combitube -can ventilate through esophagus or trachea

14. Combitube -ventilating through the esophagus

15. Combitube- ventilating through the trachea

16. Laryngeal Mask Airway (LMA)

17. Endotracheal Tubes (oral and/or nasal)
(for tracheostomy)

18. ET Tube
Note: Most late complications are caused by the cuff

19. Tracheostomy Tube
Note: Most Trach tubes have an inner and an outer cannula

20. Jackson Tracheostomy Tube
Made out of silver plated metal
Cannot prevent aspiration
Cannot facilitate mechanical ventilation

21. Cuffed Tubes
Inflatable cuffs were added to tubes to prevent aspiration and to facilitate mechanical ventilation
In doing this cuffs may also damage the tracheal mucosa
Big Problem!

22. Initial Cuff Designs High Pressure and low residual volume
Much tracheal mucosa damage

23. Modern Cuff Design Low pressure and high residual volume
Not as damaging to tracheal mucosa if managed and monitored properly

24. Markings on Tubes Size – internal diameter in mm
Distance in cm from distal end
Radiopaque line
Z79 (may also have IT)

25. Specialized Cuff Designs

26. Bivona and Kamen-Wilkinson
Cuff is made of spongy compound
Is inserted with the cuff collapsed
Pilot port is opened after insertion and cuff expands to atmospheric pressure
Hence, zero pressure gradient across the tracheal mucosa

27. Fenestrated Trach Tube
When inner cannula is removed , a window (fenestration) opens in the outer cannula
Allows patient to breath through upper airway
Used to wean patient from artificial airway

28. Trach Button Used to wean patient from artificial airway
When plugged patient uses upper airway
Button keeps stoma patent
Inner cannula can be removed for suctioning

29. Tracheostomy Tube with a Speaking Valve

30. Carlens Tube Allows isolation of right and left main stem bronchi
Used for ILV

31. C.A.S.S. Tube Continuous Aspiration of Subglottic Secretions
May help prevent Ventilator Acquired Pneumonia (VAP)

32. ET Tube Sizes
Most adults will need an internal diameter of 7.5mm to 10 mm
Males usually require larger size than female
Bronchoscopy requires at least a 7.5mm internal diameter

33. Tracheotomy vs ET Tube ET tubes can be tolerated for 10-28 days
A daily evaluation should made and if the artificial airway is determined to be needed for longer, than a tracheotomy with tracheostomy should be performed

35. Endotracheal Intubation
Can be done transorally or transnasally
Transorally is usually faster and is also easier to learn

36. “Tubular, Man”

37. Esophageal Obturator Airway (EOA)
Used for adults only
Is a “field” airway when ET tube can’t be utilized

41. EOA An effective seal at the mask is crucial for ventilation
Like BVM, it is best if two people work together
The EOA should not be removed until an ET tube is in place

42. Lanz Tube (ET or Trach)
Allows maintenance of a constant pressure in cuff once pilot port is closed
Equilibration is maintained between external balloon and cuff