ARTIFICIAL AIRWAYS

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Definition

A tube or tube-like device that is inserted through the nose, mouth, or into the trachea to provide an opening for ventilation

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Types of Artificial Airways

Oropharyngeal airways Nasopharyngeal tubes Orotracheal tubes Nasotracheal tubes Tracheostomy tubes Esophageal obturator airway Cricothyroid tubes

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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
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Indications (contd)

Reflexes (contd)
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
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Indications (contd)

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

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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

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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
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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

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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
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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

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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

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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%

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Complications and Hazards of Tracheostomies

Postsurgical bleeding Infection Mediastinal emphysema Pneumothorax Subcutaneous emphysema Stoma collapse (should not be moved or changed first 36 hours)

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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

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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

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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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