Page 173 - Clinical Application of Mechanical Ventilation

Special Airways for Ventilation 139

ESOphAGEAL-TRAChEAL COMBITuBE (ETC)

The esophageal-tracheal combitube (ETC), also called pharyngealtracheal lumen
esophageal-tracheal combi-
tube (ETC): An airway that may airway and esophageal-tracheal airway, is a combination of esophageal and endotra-
be inserted into the esophagus or cheal tube in one unit (e.g., Combitube™, by Kendall-Sheridan Corporation, Argyle,
trachea.
NY). Due to its design, ventilation is possible when the ETC is inserted blindly ei-
ther into the trachea or esophagus (Liao & Shalit, 1996). The ETC can be inserted
easily by unskilled personnel (Yardy, Hancox & Strang, 1999), and it has been used
The ETC is inserted
blindly either into the trachea successfully as an alternate artificial airway in patients outside the hospital (Blostein,
or esophagus. Koestner & Hoak, 1998; Hoak & Koestner, 1997; Rumball & MacDonald, 1997).
Ventilation is provided via a 15-mm airway connector at the proximal end of the ETC.
There are two cuffs on the ETC, a proximal latex pharyngeal cuff (100 mL) and a
PVC cuff (15 mL) near the distal end of the tube (Figure 5-10). Both lumens on the
Both lumens on the ETC
can be used to provide venti- ETC can be used to provide ventilation. Lumen 1 is used when the tube enters the
lation. Lumen 1 is used when
the tube enters the esophagus esophagus and the distal cuff seals off the esophagus. Lumen 2 is used when it is in the
and lumen 2 is used when it is trachea and the proximal cuff seals off the trachea. Figure 5-11 shows the relative posi-
in the trachea.
tions of the ETC when it enters the esophagus or trachea.

Insertion and use of ETC
Following blind
intubation with a esophageal-
tracheal combitube (ETC), The ETC can be inserted with or without a laryngoscope. The tube is properly
ventilation should be
attempted initially through inserted once the black rings lie opposite the front teeth. After insertion, both cuffs
lumen 1 of the ETC.
are inflated immediately. Since the ETC is designed to provide ventilation when the
tube is in the trachea or esophagus, it does not matter whether the tube enters the
esophagus or trachea.
During blind intubation, the ETC is more likely to go into the esophagus. There-
blind intubation: Insertion of
an artificial airway without use of fore, ventilation through the ETC should be done initially via lumen 1. When the
visual aid or under direct vision. distal end of the ETC is in the esophagus, air goes through the side ports, becomes
trapped between the cuffs, and is forced into the trachea. If ventilation via lumen 1

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Figure 5-10 A pharyngealtracheal lumen airway (PTLA).

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