Artificial Airways

Midterms Topic- Aug 14

Instructor: Bea Eunice G. Cercenia, RTRP

 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
 Inflatablecuffs 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
 TheEOA 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