artificial airways rc 275 indications for an artificial airway to facilitate mechanical ventilation...
TRANSCRIPT
![Page 1: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/1.jpg)
Artificial Airways
RC 275
![Page 2: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/2.jpg)
Indications for an Artificial Airway
To facilitate mechanical ventilation To protect the airway, eg, prevent
aspiration To facilitate suctioning To relieve upper airway obstruction
![Page 3: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/3.jpg)
Oropharyngeal Airways
Used to prevent tongue from occluding the airway
![Page 4: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/4.jpg)
![Page 5: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/5.jpg)
A conscious patient can not tolerate this airway!
![Page 6: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/6.jpg)
![Page 7: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/7.jpg)
Oropharyngeal Airway Sizes
00-6 Most adults take between 3 and 5 Correct size by measuring from corner
of mouth to bottom of earlobe
![Page 8: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/8.jpg)
Oropharyngeal Airway Insertion
![Page 9: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/9.jpg)
Nasopharyngeal Airways Prevent tongue
from blocking airway
Tolerated by conscious or semi-conscious patient
![Page 10: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/10.jpg)
Nasopahryngeal Airway Sizes
Are in French units Measure from tip of
nose to bottom of earlobe
Also base on diameter of patient’s nares
![Page 11: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/11.jpg)
Nasopharyngeal Airway Insertion
![Page 12: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/12.jpg)
Nasopharyngeal Airway Insertion (cont.)
![Page 13: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/13.jpg)
The Combitube-can ventilate through esophagus or trachea
![Page 14: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/14.jpg)
Combitube-ventilating through the
esophagus
![Page 15: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/15.jpg)
Combitube-ventilating through the
trachea
![Page 16: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/16.jpg)
Laryngeal Mask Airway (LMA)
![Page 17: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/17.jpg)
Endotracheal Tubes(oral and/or nasal)
Tracheal Tubes
(for tracheostomy)
![Page 18: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/18.jpg)
ET Tube
Note: Most late complications are caused by the cuff
![Page 19: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/19.jpg)
Tracheostomy Tube
Note: Most Trach tubes have an inner and an outer cannula
![Page 20: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/20.jpg)
Jackson Tracheostomy Tube
Made out of silver plated metal
Cannot prevent aspiration
Cannot facilitate mechanical ventilation
![Page 21: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/21.jpg)
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!
![Page 22: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/22.jpg)
Initial Cuff Designs High Pressure and
low residual volume Much tracheal
mucosa damage
![Page 23: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/23.jpg)
Modern Cuff Design Low pressure and
high residual volume
Not as damaging to tracheal mucosa if managed and monitored properly
![Page 24: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/24.jpg)
Markings on Tubes Size – internal
diameter in mm Distance in cm from
distal end Radiopaque line Z79 (may also have
IT)
![Page 25: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/25.jpg)
Specialized Cuff Designs
![Page 26: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/26.jpg)
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
![Page 27: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/27.jpg)
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
![Page 28: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/28.jpg)
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
![Page 29: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/29.jpg)
Tracheostomy Tube with a Speaking Valve
![Page 30: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/30.jpg)
Carlens Tube Allows isolation of
right and left main stem bronchi
Used for ILV
![Page 31: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/31.jpg)
C.A.S.S. Tube Continuous
Aspiration of Subglottic Secretions
May help prevent Ventilator Acquired Pneumonia (VAP)
![Page 32: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/32.jpg)
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
![Page 33: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/33.jpg)
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
![Page 34: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/34.jpg)
![Page 35: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/35.jpg)
Endotracheal Intubation Can be done transorally or
transnasally Transorally is usually faster and is
also easier to learn
![Page 36: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/36.jpg)
“Tubular, Man”
![Page 37: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/37.jpg)
Esophageal Obturator Airway (EOA)
Used for adults only Is a “field” airway
when ET tube can’t be utilized
![Page 38: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/38.jpg)
![Page 39: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/39.jpg)
![Page 40: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/40.jpg)
![Page 41: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/41.jpg)
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
![Page 42: Artificial Airways RC 275 Indications for an Artificial Airway To facilitate mechanical ventilation To protect the airway, eg, prevent aspiration](https://reader035.vdocuments.us/reader035/viewer/2022062320/56649d895503460f94a6f3c8/html5/thumbnails/42.jpg)
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