Page 205 - Clinical Application of Mechanical Ventilation

Airway Management in Mechanical Ventilation 171

Thumb and Index Finger
Apply Cricoid Pressure
Adam’s Apple

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Thyroid Cartilage

Cricoid Cartilage
Figure 6-14 Sellick’s (cricoid pressure) maneuver.

MANAGEMENT OF ENDOTRACHEAL
AND TRACHEOSTOMY TUBES

Once the patient is successfully intubated with an artificial airway, the airway must be
managed properly to prevent complications. Failure to secure the airway may lead to
inadvertent or self-extubation. Excessive cuff pressures may lead to tracheal mucosal
tissue injuries. Finally, failure to humidify the secretions makes its removal from the
artificial airway difficult and this condition may lead to pneumonia and atelectasis.

Securing Endotracheal and Tracheostomy Tubes

The ET tube can be secured by using adhesive tape or a commercially made harness.
As shown in Figure 6-15A (oral intubation) and 6-15B (nasal intubation) they are
used around the base of the head or neck for maximal security. Caution must be
exercised as this technique may cause facial swelling and injuries to the lips when
applied around the neck too tightly.
Since moisture often gathers between the tape and skin, tapes that can withstand
moisture are more desirable. Zinc oxide base tape (by Hy-Tape International, New
York) is one that sticks well to the skin when exposed to moisture.
Tracheostomy tubes are secured by tying a string to the two openings on the collar.
The string goes around the neck for good fit and security.

Cuff Pressure

The estimated capillary perfusion pressure in the trachea is in the range of 25 mm
Hg to 35 mm Hg. Lateral wall cuff pressure higher than this range can cause muco-
sal ischemia and tracheal wall tissue necrosis (Seegobin et al., 1984).

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