Page 165 - Clinical Application of Mechanical Ventilation

Special Airways for Ventilation 131

Openings

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Blind
Distal End

Figure 5-5 An esophageal obturator airway (EOA).

face during ventilation (Burton et al., 1997; White, 2004). Figure 5-5 shows an
esophageal obturator airway.
The opening at the proximal end of the tube attaches to a ventilation bag. The
small holes at the hypopharyngeal level allow ventilation to the lungs. The closed
distal end of the EOA prevents aspiration or removal of air or gastric contents from
the stomach. Since an EOA is inserted into the esophagus, the cuff at the distal
Since an EOA is inserted end must be inflated during use to prevent air from entering the stomach (Wilkins
into the esophagus, the cuff et al., 2003; White, 2004).
at the distal end must be
inflated during use to prevent
air from entering the stomach.
Insertion of EOA

The cuff of an EOA is first inflated with 20 to 30 mL of air to check for cuff
integrity and leaks. The cuff is then deflated, and the proximal end of the EOA is
inserted through the opening of a mask. The distal end of the tube is lubricated
with a water-soluble lubricant and then inserted into the patient’s esophagus
until the mask rests on the patient’s face. Due to the large volume of air used
to inflate the cuff, it is extremely important to check for proper tube placement
before cuff inflation and ventilation. Asphyxia and tracheal damage are severe
complications if the cuff is inflated while the tube is misplaced in the trachea
(Wilkins et al., 2003; White, 2004). Table 5-3 lists other precautions during use
of the EOA.
The EOA is not designed to be used as an artificial airway for positive pressure
The EOA is not designed ventilation. Since it is used as a temporary airway, it should be replaced with an
to be used as an artificial
airway for positive pressure endotracheal intubation as soon as feasible. With the EOA in place, endotracheal
ventilation. intubation is done using the standard procedure. After endotracheal intubation,
bilateral breath sounds should be verified as the endotracheal tube may follow the
EOA and enter the esophagus. After ascertaining correct placement, the endotra-
cheal tube is secured prior to removal of the EOA. Suction setup should be ready in
case of vomiting during removal of the EOA.

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