Page 196 - Clinical Application of Mechanical Ventilation

162 Chapter 6

devices for intubation, including the low-cost lighted stylet, flexible fiberoptic sty-
lets, and video systems (Liem et al., 2003). When compared to direct laryngoscopy,
the optical stylet has equivalent intubation time, less hemodynamic variability, less
trauma and sore throat, and less failed intubation of difficulty airway. The optical
stylet does not require new skills and is easy to learn. It also offers a faster setup than
the traditional fiberoptic bronchoscope and a low acquisition and maintenance cost.
(Gravenstein et al., 2004).

Selection of Endotracheal Tube

Mentally count from 1 The size of an ET tube should be the largest one appropriate to a patient. Compared
to 30 when you begin the to a smaller ET tube, a larger one offers lower airflow resistance, and lower (peak,
intubation attempt.
plateau, mean) airway pressures. A larger ET tube also improves dynamic compli-
ance and facilitates secretion removal.
Table 6-3 shows the estimated size of the ET tube based on body size. In addition
Intubation attempts to the body weight or body size, final selection of an ET tube should be based on the
lasting longer than 30 sec
may cause hypoxia and clinical condition and tolerance of the patient.
arrhythmias.
Ventilation and Oxygenation

Before each intubation attempt, the patient must be adequately ventilated and
oxygenated. If the patient is not breathing spontaneously, a resuscitation bag/mask
system is used to provide ventilation and oxygenation (Figure 6-9).
If an intubation attempt is not successful after 30 sec, the ET tube and laryngo-
scope blade should be removed immediately and the patient ventilated with a bag/
mask system and 100% oxygen. Ventilation and oxygenation should continue for at

TABLE 6-3 Estimation of ET Tube Size

Patient Estimated Size*

Neonate (, 1000 grams) 2.5 mm ID

Neonate (1000 to 2000 grams) 3.0 mm ID
Neonate (2000 to 3000 grams) 3.5 mm ID

Neonate (. 3000 grams) 4.0 mm ID
Child (1 to 2 years) 4.5 mm ID

Child (2 to 12 years) 4.5 1 (age/4) mm ID

Adult female 7.0 or 7.5 mm ID
Adult male 7.5 or 8.0 mm ID

*,size 6 uncuffed, size 6 cuffed or uncuffed, size 6 cuffed (Graber, 2004).
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