Artificial Airways RC 275

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

Oropharyngeal Airways Used to prevent tongue from occluding the airway

A conscious patient can not tolerate this airway!

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

Oropharyngeal Airway Insertion

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

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

Nasopharyngeal Airway Insertion

Nasopharyngeal Airway Insertion (cont.)

The Combitube -can ventilate through esophagus or trachea

Combitube -ventilating through the esophagus

Combitube- ventilating through the trachea

Laryngeal Mask Airway (LMA)

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

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

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

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

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!

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

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

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

Specialized Cuff Designs

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

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

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

Tracheostomy Tube with a Speaking Valve

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

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

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

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

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

“Tubular, Man”

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

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

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