Page 195 - Clinical Application of Mechanical Ventilation

Airway Management in Mechanical Ventilation 161

wide). During expiration, the ET tube may bounce off the closed vocal cords and
enter the esophagus.
10-mL syringe. A syringe with a capacity of 10 mL or larger is used to test the pilot
For adult ET tubes, the
syringe used to inflate the cuff balloon and ET tube cuff before intubation and to inflate the cuff after intubation.
should have a capacity of After testing the integrity of the pilot balloon and cuff, air is withdrawn from the
10 mL or larger.
cuff to the syringe. The air-filled syringe may be left attached to the pilot balloon for
rapid inflation of the cuff immediately after intubation.

Water-soluble lubricant. A water-soluble lubricant is used to lubricate the distal end
Use only a water-soluble
lubricant on the distal end of of the ET tube for easy insertion into the trachea. Petroleum or oil-based lubricants
an ET tube. must not be used in ET intubation. Once entering the lungs, they can cause adverse
reactions to the airways and lung parenchyma.

Tape. Tape is used to secure the ET tube so that the tube will not move too high
Petroleum or oil-based
lubricants must not be used causing inadvertent extubation, or too low leading to main-stem intubation. Benzoin
as they can cause adverse or other commercially available solutions may be effective in making the tape more
reactions to the lungs.
adhesive to the damp skin. Zinc oxide base tape (by Hy Tape Corporation, New
York) also sticks well to the skin when it is exposed to moisture.

Stethoscope. A stethoscope is needed to auscultate bilateral breath sounds immedi-
If the ET tube is not
secured properly, inadvertent ately after intubation.
extubation or main-stem
intubation may result. Stylet. A flexible stylet wire guide is placed inside the ET tube to form a desired cur-
vature and to make it more rigid for ease of intubation. Use of a stylet is not required
for successful oral intubation. A stylet is not used in nasal intubation.
When a stylet is used, make certain that its end does not extend below the tip of
A stylet is not required the ET tube because the stylet can traumatize the tracheal wall. As a standard prac-
for successful oral intubation
and it is not used in nasal tice, the portion of stylet extending from the proximal end of the ET tube (outside
intubation.
the patient’s mouth) is bent before intubation to prevent it from slipping deep inside
the ET tube.
Topical anesthetic. A topical anesthetic with decongestant (e.g., such as 4% lidocaine
with oxymetazoline) may be used to numb and vasoconstrict the mucosal mem-
brane. Use of a topical anesthetic is not feasible in emergency intubation or neces-
sary in unconscious patients. It is useful to reduce the incidence of bronchospasm
and vomiting when elective intubation is done in conscious and alert patients.

Magill forceps. Magill forceps are used to perform nasal intubation. After the ET
Magill forceps are used to tube has been inserted through the nostril and becomes visible through the mouth,
perform nasal intubation.
the laryngoscope blade and Magill forceps are used together to guide the ET tube
into the trachea under direct vision.

Special Visualization Devices

A fiberoptic endoscope was used to perform nasal intubation as early as 1967
(Murphy, 1967). The first noncommercial fiberoptic laryngoscope was introduced
in 1974 by American Optical. Currently, there are different types of visualization

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