Page 216 - Clinical Application of Mechanical Ventilation

182 Chapter 6

COMPLICATIONS OF ENDOTRACHEAL AIRWAY

Endotracheal intubation is an extremely useful procedure in the establishment of
an artificial airway but it also carries many potential complications. As shown in
Table 6-12, complications may develop at different stages of intubation and extuba-
tion. Some conditions are life-threatening (e.g., esophageal intubation, bradycardia)
while others are minor and often reversible (e.g., pressure sores, hoarseness). It is es-
sential to understand and recognize the potential complications so that appropriate
steps may be taken to avert harmful outcomes.

TABLE 6-12 Complications Related to Use of Endotracheal Tube

Sequence of Events Complications
During intubation Trauma to teeth and soft tissues
Esophageal intubation
Vomiting and aspiration
Hypoxia due to prolonged intubation
attempt
Arrhythmias
Bradycardia due to vagal stimulation

While intubated Obstruction by secretions
Pneumonia and atelectasis
Kinking of ET tube
Aspiration (from feeding and
ineffective cuff)
Mucosal injuries
Laryngeal damage
Improper tube position (too high,
too low)
Pressure sores around ET tube
Inadvertent extubation
Sinusitis (nasal intubation)
Immediately after Aspiration
extubation Laryngospasm
Hoarseness
Laryngeal and subglottic edema

Following extubation Mucosal injuries
Laryngeal stenosis
Tracheal inflammation, dilation,
stenosis
Vocal cord paralysis

(Data from Chang, 1995; Dillier et al., 2004; White, 2002; Whitten, 1997; Young et al., 1995.)
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