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)

Tracheal Tubes

(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