Book contents
- Frontmatter
- Contents
- Contributors
- Foreword
- Preface
- Introductory Notes
- 1 Physiology of ventilation and gas exchange
- 2 Assessing the need for ventilatory support
- 3 Oxygen therapy, continuous positive airway pressure and non-invasive ventilation
- 4 Management of the artificial airway
- 5 Modes of mechanical ventilation
- 6 Oxygenation
- 7 Carbon dioxide balance
- 8 Sedation, paralysis and analgesia
- 9 Nutrition in the mechanically ventilated patient
- 10 Mechanical ventilation in asthma and chronic obstructive pulmonary disease
- 11 Mechanical ventilation in patients with blast, burn and chest trauma injuries
- 12 Ventilatory support: extreme solutions
- 13 Heliox in airway obstruction and mechanical ventilation
- 14 Adverse effects and complications of mechanical ventilation
- 15 Mechanical ventilation for transport
- 16 Special considerations in infants and children
- 17 Tracheostomy
- 18 Weaning, extubation and de-cannulation
- 19 Long-term ventilatory support
- 20 The history of mechanical ventilation
- Glossary
- Index
4 - Management of the artificial airway
Published online by Cambridge University Press: 14 October 2009
- Frontmatter
- Contents
- Contributors
- Foreword
- Preface
- Introductory Notes
- 1 Physiology of ventilation and gas exchange
- 2 Assessing the need for ventilatory support
- 3 Oxygen therapy, continuous positive airway pressure and non-invasive ventilation
- 4 Management of the artificial airway
- 5 Modes of mechanical ventilation
- 6 Oxygenation
- 7 Carbon dioxide balance
- 8 Sedation, paralysis and analgesia
- 9 Nutrition in the mechanically ventilated patient
- 10 Mechanical ventilation in asthma and chronic obstructive pulmonary disease
- 11 Mechanical ventilation in patients with blast, burn and chest trauma injuries
- 12 Ventilatory support: extreme solutions
- 13 Heliox in airway obstruction and mechanical ventilation
- 14 Adverse effects and complications of mechanical ventilation
- 15 Mechanical ventilation for transport
- 16 Special considerations in infants and children
- 17 Tracheostomy
- 18 Weaning, extubation and de-cannulation
- 19 Long-term ventilatory support
- 20 The history of mechanical ventilation
- Glossary
- Index
Summary
Introduction
In this chapter, endotracheal intubation will refer to trans-laryngeal intubation (that is oral or nasal intubation of the trachea), and tracheal intubation will refer to either endotracheal intubation or intubation via a tracheostomy (Figure 4.1). A supraglottic airway is an airway that does not pass across the vocal cords, such as an oropharyngeal airway or a laryngeal mask.
Intubation of the trachea with a cuffed tube is the only way to simultaneously provide a secure airway, repeated access to the trachea and ventilatory support. Unfortunately, the placement of an artificial airway, be it a supraglottic airway or an endotracheal or tracheostomy tube, will bypass many of the patient's natural defences and thus increase the risk of upper and lower airway colonization, aspiration and infection. To enable the patient to tolerate the airway, the use of sedative, analgesic or muscle relaxants may be required with the resultant risk of cardiovascular, respiratory and neuromuscular complications. Therefore, unless absolutely necessary, it is desirable to avoid the use of artificial airways, for example, by using face mask oxygen or an external airway interface to achieve non-invasive ventilation. Indeed, it has become clear that non-invasive ventilation as opposed to tracheal intubation can, in some circumstances, reduce morbidity and mortality in the critically ill (Chapter 3).
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- Core Topics in Mechanical Ventilation , pp. 54 - 87Publisher: Cambridge University PressPrint publication year: 2008
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