Page 190 - Clinical Application of Mechanical Ventilation

156 Chapter 6

type of foam cuff does not require manual inflation with a syringe. Rather, the self-
inflating nature of the foam rubber provides a continuous seal while maintaining
minimal tracheal wall pressure.
The cuff of the Bivona Fome-Cuf ® tube can be inflated either by attaching the red
wing pilot port to the side port auto control airway connector (if available) or by
leaving the red wing pilot port open to room air for self-inflation. The important
point is to check for cuff leak or obstruction. Cuff leak is evident when the gas leak
is audible and the expired tidal volume is lower than the set tidal volume. Cuff
obstruction may be present when the airway pressures are higher than the baseline
measurement. In both cases, the patient’s vital signs and oxygen saturation would
show corresponding changes.
Tracheostomy button. The tracheostomy button is used to maintain the stoma of
The tracheostomy button
is used to maintain the stoma a patient on a temporary or permanent basis. The button offers several advan-
of a patient on a temporary or tages. Direct access to the trachea facilitates tracheal suctioning and removal of
permanent basis.
secretions. In emergency situations, the button can be replaced with a traditional
tracheostomy tube without the need for another tracheotomy. The buttons are also
suitable for patients who may require repeated tracheostomies (e.g., myasthenia
gravis, quadriplegia).

INTUBATION PROCEDURE

Intubation is a fairly simple procedure. In order to become proficient in this pro-
cedure one may need to exercise good organization and frequent practice. The pro-
cedure described below provides the basics and it may vary somewhat depending
on the preference of an individual and existing protocol of the respiratory therapy
department.

Preintubation Assessment and Signs
of Difficult Airway

Prior to intubation, the patient must be assessed to rule out any potential contra-
indications to include head injury, cervical spine injury, airway burns, and facial
trauma (Finucane et al., 2010). Anesthesia consultation is advised in cases of unfa-
miliarity or difficult intubation.
The degree of difficulty in intubation due to anatomical structures can be evalu-
Mallampati classification: A ated by using the Mallampati classification method (Figure 6-4). This method is
method to evaluate the degree of based on the anatomical structures visible with the mouth wide open and tongue
difficulty in intubation.
protruded in a sitting position. Ease of oral intubation ranges from Class 1 (easiest)
to Class 4 (most difficult) (Table 6-2) (Finucane et al., 2010).
Other signs of difficult airway include: increased size of tongue in proportion
to pharyngeal size, neck mass, anterior larynx position, decreased mandibular

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