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Endotracheal intubation

See Tracheal intubation

Often required for major surgical procedures and for respiratory support in clinically ill patients.

Appropriate position is >1cm above the carina.

In children the trachea is significantly shorter than in adults making it more difficult for proper placement.

The tube is easily displaced by rotation, flexion and head extension.

Right mainstem intubations common.

Confirmation of proper tube placement achieved by auscultation of bilateral lung sounds.

Auscultation in children not as reliable as in adults to confirm proper tube placement.

Appropriate insertion depth estimated to be 3 x endotracheal tube size.

Chest x-ray best way to evaluate tube position.

Plays a central role in contemporary emergency medical care, but remains controversial.

Paramedic endotracheal tube insertion is associated with significant rates of unrecognized tube misplacement or dislodgement, need for multiple attempts, and insertion failure.

Endotracheal tubal insertion is associated with iatrogenic hyperventilation and chest compression interruptions.

Failure to intubate occurs in fewer than 1/5000 elected general anesthesia procedures and requires surgical airway rescue in fewer than 1/50,000 cases.

Failure to intubate can result in major complications associated with long-term morbidity and account for 25% of an anesthesia related deaths.

United kingdom study showed that one of 22,000 cases of tracheal intubation was associated with severe adverse airway management events in the operating room, such as death, brain damage, and need for an emergency surgical airway, or unplanned ICU admission.

In a randomized clinical trial of 1102 critically ill patients undergoing tracheal intubation, use of a bougie did not significantly increase the incidence of successful intubation on the first attempt compared with the use of an endotracheal tube with stylet.

 

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