Understanding Endotracheal Tubes for Critical Care

Endotracheal Tubes 

What is an Endotracheal Tube?

An endotracheal tube, commonly referred to as an ET tube, is a thin, flexible plastic tube that is inserted through the mouth and then down into the trachea (windpipe) and lungs to help patients breathe during surgical and emergency situations that compromise spontaneous breathing. The tube ensures an open airway and provides a pathway to deliver oxygen or mechanical ventilation to the lungs while bypassing the nose and mouth.

Indications for Endotracheal Intubation

Some common medical situations where endotracheal intubation may be required include:

Trauma Care and Surgery

Endotracheal Tube are frequently used during trauma and surgical procedures where anesthesia needs to be administered and the airway needs to be protected. For example, ET tubes allow for mechanical ventilation during major surgeries, assist breathing during recovery from anesthesia, and protect the airway during facial or neck trauma.

Respiratory Failure

Patients suffering from respiratory failure or respiratory distress due to conditions like pneumonia, lung injury, asthma attack, or drug overdose may require endotracheal intubation to maintain adequate oxygen levels and ventilation support. The tube acts as a protected airway when spontaneous breathing is compromised.

Cardiac Arrest

Endotracheal intubation is crucial during cardiopulmonary resuscitation for a cardiac arrest patient to maintain an open airway, maximize oxygen delivery through bag valve mask ventilation or mechanical ventilator support, and protect the airway from gastric contents during CPR compressions.

Components of an Endotracheal Tube

While ET tubes vary slightly between manufacturers, they generally consist of the following core components:

Tube - The inner lumen that provides an open airway pathway. It is flexible but reinforced to prevent kinking. Tubes come in various sizes based on a patient's age, weight and anatomy.

Cuff - An inflatable balloon located at the distal end of the tube within the trachea. The cuff is inflated with air to form an airtight seal in the trachea and prevent aspiration past the tube.

Murphy's eye - A small opening located near the end of the tube inside the cuff to allow drainage of secretions above the cuff and prevent obstruction.

Connector - Attaches the endotracheal tube to a ventilator circuit, breathing bag, or anesthesia circuit to facilitate mechanical ventilation or oxygenation. The standard 15mm connector is most common.

Stylet - A plastic, angled device inserted into the lumen of the tube during intubation to stiffen the tip and help guide placement into the trachea. It is removed once positioned.

Endotracheal Tube Placement and Securement

Endotracheal intubation of the trachea is a life-saving procedure typically performed by critical care physicians, nurses, paramedics or respiratory therapists trained in emergency airway management and advanced airway skills. Placement of the tube involves:

1. Preoxygenating the patient and administering paralytics/anesthesia for intubation if indicated.

2. Inserting a laryngoscope blade into the mouth to lift the tongue and visualize the vocal cords.

3. Guiding the tip of the deflated ET tube between the vocal cords under direct line of sight into the trachea.

4. Inflating the cuff with air to seal the trachea and auscultating breath sounds to confirm proper positioning.

5. Securing the tube with tape across the patient's mouth and connecting to the ventilator.

6. Verifying correct placement with capnography (exhaled CO2 detection) and chest rise visualization.

7. Documenting tube size, depth, and initial position on the patient.

Ongoing Care with Endotracheal Tubes

Once properly positioned, endotracheal tubes require ongoing critical care and monitoring to ensure patent airway flow and minimize risks. This includes:

- Monitoring for possible extubation or accidental decannulation of the tube

- Suctioning secretions above and below the cuff as needed through the Murphy eye port

- Checking cuff pressure to maintain an adequate seal without damaging tissue

- Repositioning or replacing tubes if dislodged to maintain airway access

- Providing sedation or paralytics as indicated for ventilated patients

- Weaning ventilator settings and attempting extubation as clinical condition improves

- Documenting tube position, cuff pressure, and condition of tube/patient airway regularly

Complications of Endotracheal Intubation

While lifesaving when performed properly by trained staff, endotracheal intubation does carry risks if not carefully managed, such as:

- Aspiration of gastric contents above or below the cuff

- Vocal cord or airway trauma from tube insertion

- Pneumonia from constant tube contact or inadequate secretions management

- Tracheal swelling, damage, or stenosis from cuff pressure over-inflation

- Accidental extubation before adequate spontaneous breathing returns

- Infection risk if aseptic technique not followed during placement or maintenance

By understanding the key components and steps involved as well as monitoring for complications, critical care teams can safely utilize endotracheal tubes as a vital tool to help patients in respiratory distress or failure breathe. Proper training, technique, and care is essential given the risks.

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Money Singh is a seasoned content writer with over four years of experience in the market research sector. Her expertise spans various industries, including food and beverages, biotechnology, chemical and materials, defense and aerospace, consumer goods, etc. (https://www.linkedin.com/in/money-singh-590844163)