ARTIFICIAL AIRWAYS

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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