Page 13 - Critical Care Notes

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Artificial Airways and Mechanical Ventilation
Artificial Airways
Endotracheal Tube
■ Adult oral tube sizes: males, 8.0–8.5 internal diameter (I.D.) (mm); females,
7.0–8.0. I.D. (mm).
■ Placement is 2–3 cm above the carina. Verify by auscultating for breath
sounds bilaterally, uniform up-and-down chest movement, CXR, and check-
ing ETCO 2 immediately after intubation.
■ Cuff pressure: 20–25 mm Hg.
Rapid Sequence Induction (RSI): Minimizes time to intubation and secures a
patent airway.
■ Procedure outline:
■ Preoxygenate patient with 100% O 2 .
■ Induction drug administered: etomidate, propofol, ketamine, thiopental
or scopolamine.
■ Neuromuscular blocking agent administered: succinylcholine.
■ Apply cricoid pressure.
■ ETT inserted.
■ Nursing concerns:
■ Know patient’s K + level.
■ Have routine intubation supplies available.
■ Check for workable suction source and provide regular suction catheter
and Yankauer catheter.
■ Provide emotional support to patient and notify patient’s family of rapid
induction of ETT.
Cuff pressure can be monitored via a calibrated aneroid manometer device.
Connect manometer to cuff. Deflate cuff. Reinflate cuff in 0.5-mL increments
until desired cuff pressure is achieved. Check cuff pressure every 8–12 hr or per
agency protocol.
Tracheostomy Tube
■ Tracheostomy tubes may be cuffed or uncuffed and have either a reusable
or disposable inner cannula. Both fenestrated and Passy-Muir valves allow
the patient to speak.
■ Size will vary.
■ Cuff pressure: 20–25 mm Hg.
■ Early replacement of ETT with tracheotomy has not been shown to improve
patient outcomes.
■ Other artificial airways include oropharyngeal airway and nasopharyngeal
airway.
BASICS