Page 197 - Clinical Application of Mechanical Ventilation

Airway Management in Mechanical Ventilation 163

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Figure 6-9 Correct use of a mask to manually ventilate a patient.

least 30 sec or until the pulse oximetry (SpO ) reading returns to a satisfactory level
2
(e.g., SpO . 95%).
2
Oral Intubation

The sequence outlined in Table 6-4 provides a general procedure for oral intubation.
The proper depth of an The procedure should be modified to suit individual situations and to comply with
oral ET tube is guided by the
distance marking (e.g., 22 cm) existing protocols. The proper depth of an oral ET tube is guided by the distance
on the ET tube at the lips or marking (e.g., 22 cm) on the ET tube at the lips or incisors.
incisors.

Nasal Intubation

The procedure for nasal intubation is similar to that for oral intubation. In nasal
intubation, the ET tube is inserted through the nostril and then guided by the Ma-
gill forceps into the trachea (Table 6-5).

Blind Intubation. In alert and cooperative patients who are breathing spontaneously,
“Blind” nasal intubation
is done by advancing the ET “blind” nasal intubation may be done by inserting the ET tube into a nostril and
tube slowly during spontane- advancing it slowly during inspiratory efforts. When the distal end of the ET tube
ous inspiratory efforts by
listening for air movement approaches the trachea, air movement can be heard through the ET tube. The
through the ET tube. proper depth of a nasal ET tube is guided by the distance marking (e.g., 26 cm for
adult females and 28 cm for adult males) on the ET tube at the lips or incisors (Reed
et al., 1997). Breath sounds and a chest radiograph are done to confirm proper
The proper depth of a depth of the ET tube.
nasal ET tube is guided by the
distance marking (e.g., 26 cm
for adult females and 28 cm Common Errors
for adult males) on the ET
tube at the lips or incisors.
Errors can occur when intubation is done in a hurried fashion. They are also more
likely to occur when it is done by someone who is not proficient or experienced with
the intubation procedure. By staying calm during an intubation attempt and updat-
ing the intubation skills in a controlled setting (e.g., in operating room), errors can
be minimized or avoided.

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