Artificial Airways
Artificial Airways
Definition
* A tube or tube-like device that is inserted through the nose, mouth, or into the trachea to provide an opening for ventilation
Types of Artificial Airways
* Oropharyngeal airways
* Nasopharyngeal tubes
* Orotracheal tubes
* Nasotracheal tubes
* Tracheostomy tubes
* Esophageal obturator airway
* Cricothyroid tubes
Indications for Artificial Airways
* Relief of airway obstruction -guarantees the patency of upper airway regardless of soft tissue obstruction.
* Protecting or maintaining an airway N. have 4 main airway protect. reflexes 1. Pharyngeal reflex - 9th & 10th cranial nerves gag and swallowing
* Reflexes (cont’d) 2.Laryngeal -vagovagal reflex - will cause laryngospasm 3.Tracheal -vagovagal reflex - cough when a foreign body or irritation in trachea 4.Carinal -cough with irritation of carina
* Facilitation of tracheobronchial clearance
- mobilization of secretions from the trachea requires either an adequate cough or direct suctioning of the trachea
* Facilitation of artificial ventilation
- ventilation with a mask should on be used for short periods d/t gastric insufflation
Hazards of Artificial Airways
* Infection d/t bypassing the normal defense mechanisms that prevent bacterial contamination
* Ineffective cough maneuver
* Impaired verbal communication
* Loss of personal dignity
Oropharyngeal Airway
* Device designed for insertion along the tongue until the teeth &/or gingiva limit the insertion
* Lies between the posterior pharynx and the tongue and pushes the tongue forward
* Will activate the gag reflex, should use on unconscious patient
* Correct sizing of airway is imperative
Hazards of Oropharyngeal Airway
* If too small, may not displace tongue or may cause tongue to obstruct airway or may aspirated
* It too large, may cause epiglottis impaction
* Roof of mouth may be lacerated upon insertion
* Aspiration from intact gag reflex
Nasopharyngeal Airway
* Located so that it can provide a clear path for gas flow into the pharynx
* Is a soft rubber catheter
* Can be tolerated by the conscious patient
* Useful for patient with a soft tissue obstruction who have jaw injury or spasm of jaw muscles
* Proper sizing and insertion
Orotracheal Airway
* Used in conditions of, or leading to respiratory failure
* Usually the method of choice in emergencies that do not involve trauma to the mouth or mandible
* Oral route in usually easiest
* Accomplished by using a laryngoscope to directly visualize the trachea
Nasotracheal Airway
* More difficult route than oral
* Requires a longer and more flexible tracheal tube
* Insert through nose by touch and when in oropharynx use larynoscope and forceps (can perform “blind”)
* Usually N. T. tube is better tolerated by patient than oral
Tracheostomy Tube
* Tracheostomy is performed through the anterior tracheal wall either by the open method or percutaneous method
* Performed usually to prevent or treat long-term respiratory failure
* Decreases anatomic deadspace by 50%
Complications and Hazards of Tracheostomies
* Postsurgical bleeding
* Infection
* Mediastinal emphysema
* Pneumothorax
* Subcutaneous emphysema
* Stoma collapse (should not be moved or changed first 36 hours)
Esophageal Obturator Airway (EOA)
* Place in the esophagus to prevent stomach contents from entering the lungs while the patient is being artificially ventilated
* Cuff must be passed beyond carina before inflated
* Inflated cuff with 35 cc air
* Mask must fit tightly to ensure ventilation
Pharyngealtracheal Lumen Airway (PTL)
* Double-lumen airway combining an EOA and an endotracheal tube
* Designed to be inserted blindly
* Has an oropharyngeal cuff and a cuff that can seal off either the trachea or the esophagus
Other Specialized ET Tubes
* Rae Tube, directs the airway connection away from the surgical field
* Endotrol Tube, controls the distal tip for intubation
* Hi-Lo Jet Tube, for high freq. jet ventilation
* Laser Flex Tube, reflects a diffused beam if comes in contact with tube
* Endobronchial Tubes
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