Page 160 - Clinical Application of Mechanical Ventilation

126 Chapter 5

Learning Objectives

After studying this chapter and completing the review questions, the learner
should be able to:

Name the types of oropharyngeal airways and describe the methods to
select and insert these airways.
Describe the characteristics of an esophageal obturator airway and the
procedure to insert this airway.
List the clinical uses and limitations of a laryngeal mask airway and de-
scribe how to select, insert, and remove this airway.
List the clinical uses of an esophageal-tracheal combitube and the potential
complications of this airway.
List the clinical uses of a double-lumen endobronchial tube and the method
to select and insert this airway.

IntroductIon

In situations involving respiratory arrest, bag and mask ventilation is typically used
and may be followed by endotracheal intubation. Occasionally, endotracheal
intubation may not be successful due to unusual anatomy or difficult clinical setting.
In these cases, a special airway, such as the esophageal obturator airway, esopha-
geal gastric tube airway, laryngeal mask airway, or esophageal-tracheal combitube
(ETC), may serve as a stopgap measure for providing ventilation when bag and
mask ventilation is deemed inadequate. The double-lumen endobronchial tube is an-
other special airway for conditions where independent lung ventilation is indicated.

OROphARyNGEAL AIRwAy

An oropharyngeal airway is used to relieve upper airway obstruction if airway
oropharyngeal airway: A
device to relieve upper airway maneuvers (e.g., head tilt-chin lift, jaw thrust) fail to open an unobstructed airway
obstruction. (White, 2004). During bag-mask ventilation, an oropharyngeal airway may facili-
tate effective ventilation. It may also be used as a bite block in intubated patients.
An oropharyngeal airway should be used in patients who are sedated or uncon-
An oropharyngeal scious. For conscious patients, insertion of this airway may trigger the gag reflex
airway should be used in
patients who are sedated or and cause vomiting, and aspiration of stomach contents into the lungs.
unconscious.
Types of Oropharyngeal Airways

There are two major types of oropharyngeal airways (Figure 5-1). The Berman
airway has external side channels and ranges from size 43 mm for infants to size

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