Endotracheal tubes (ET tubes) are thin, flexible plastic tubes that are inserted through the mouth or nose down into the trachea (windpipe) to maintain an open airway and allow ventilation of a patient during surgery or when they are unable to breathe on their own effectively. ET tubes play a crucial role in emergency medicine and critical care by securing the airway and allowing for mechanical ventilation. In this article, we will explore endotracheal tubes in more depth including their design features, use in clinical practice, advantages, and potential complications.
Anatomy and Design
Endotracheal tubes come in various sizes depending on the patient’s age, gender and anatomy. The average length of an Endotracheal Tuberanges from 18-30 centimeters and they have an internal diameter of usually between 3-10 millimeters. Several design aspects are important for safe and effective use. The beveled distal end helps guide the tube into the trachea while minimizing trauma to delicate tissues. An inflatable cuff partway down the shaft allows the tube to form an airtight seal within the trachea once inflated with air. Tube markings on the shaft indicate the depth of insertion. Many tubes also have a pilot balloon connection and extension tubing attached to monitor cuff pressure.
ET tubes find widespread use in operating rooms, emergency departments and hospital ICUs for both emergency and elective procedures that require ventilatory support and airway control. Common clinical scenarios where endotracheal intubation is performed include: traumatic injuries, respiratory failure/distress, cardiac arrest, drug overdoses, burn injuries, sepsis, major surgeries under general anesthesia and more. Intubation helps secure the airway during transport and provides a ready conduit for suctioning secretions, bronchoscopy and delivery of respiratory support via mechanical ventilators.
Advantages of Endotracheal Intubation
When performed properly by trained providers, endotracheal intubation offers several advantages over other airway management techniques:
– Secures the airway against obstruction and prevents aspiration of gastric contents or secretions into the lungs.
– Provides a direct channel for delivering oxygen, anesthetic gases and administering positive pressure ventilation via ventilators.
– Allows for lung isolation techniques like bronchial blockers and selective ventilation of one lung during thoracic surgeries.
– Protects the airway from potential trauma, blood/secretions during procedures or transport.
– Monitors exhaled end-tidal carbon dioxide levels which serves as a valuable indicator of correct tube placement.
– Provides access for suctioning secretions and sampling respiratory gases.
– Allows for bronchoscopy during intubation attempts or to diagnose airway issues.
Complications of Endotracheal Intubation
While Endotracheal Intubation is a life-saving intervention, it does carry some risks if not done properly:
– Hypoxemia or inability to oxygenate the patient during intubation attempts.
– Esophageal intubation where the tube is inadvertently placed in the esophagus instead of trachea can lead to hypoxemia.
– Dental or soft tissue trauma due to forceful laryngoscopy or tube insertion.
– Airway trauma like laryngeal fractures or damage to vocal cords from multiple attempts or use of stylets.
– Pneumothorax or placement of the tube in right or left mainstem bronchus rather than trachea.
– Aspiration pneumonitis from gastric contents entering the lungs during or after intubation.
– Subglottic stenosis or narrowing of the airway below the vocal cords due to prolonged intubation or high cuff pressures.
– Ventilator-associated pneumonia from microaspiration past the cuff or colonization of the inner lumen.
These complications can often be avoided with thorough training, appropriate tube selection, careful technique and confirmation of proper placement.
Monitoring Endotracheal Tube Position
As detailed above, misplaced or malpositioned ET tubes can have dire consequences. Various techniques are used after intubation to ensure the tube is situated correctly in the trachea rather than esophagus or a bronchus:
– Visualization of tube passing through vocal cords during laryngoscopy.
– Condensation in tube from patient exhalations indicates placement in air-filled trachea rather than fluid-filled esophagus.
– Adventitious breath sounds on auscultation of both lung fields.
– Rise and fall of chest with ventilations and absence of epigastric sounds.
– End-tidal carbon dioxide detection on capnography to validate ventilation of functional lung tissue.
– Chest x-ray to radiographically confirm tube path and position in trachea.
Endotracheal tubes are a critical adjunct that enable management of a patient’s airway and delivery of respiratory support in many acute and emergency situations. Proper training, familiarity with tube design features, confirmation of placement, and judicious use help maximize benefits while mitigating complications. With continued advances, endotracheal tubes will remain a mainstay of critical care practice for securing the airway.
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it