Airway and Ventilation

Terms Respiration: breathing (External and internal) Ventilation: breathing in of air or oxygen or providing breaths artificially. Respiratory distress: increased work of breathing; sensation of shortness of breath Respiratory failure: reduction of breathing to the point where oxygen intake is not sufficient to support life. Respiratory arrest: stopping breathing completely. Artificial Ventilation: forcing air or oxygen into the lungs when the patient has stopped breathing or has inadequate breathing.

Review of Anatomy & Physiology Nose Mouth Pharynx Larynx Trachea Bronchi Bronchioles Alveoli Lungs Diaphragm

Airway Control Manual cleaning of the airway Manual maneuvers Jaw thrust Chin lift Suctioning

Basic Adjuncts – Oropharyngeal Airway Indications: Patient who is unable to maintain his airway To prevent intubated patient from biting ETT. Contraindications: Conscious or semiconscious patient. Complications: Gagging and vomiting Laryngeal spasm in conscious patient

Basic Adjuncts – Nasopharyngeal Airway Indications: Patient who is unable to maintain his airway Contraindications: No need for airway adjunct. Complications: Bleeding caused by insertion

Endotracheal Intubation It is the preferred method of airway control Isolated the airway Allows for ventilation with 100 % oxygen Eliminates the need to maintain an adequate mask to face seal Decreases the risk of aspiration Facilitates deep tracheal suctioning Prevents gastric inflation provides an additional route for drug administration

Endotracheal Intubation Indications: Patient who is unable to protect his airway Patient with oxygenation problem requiring high concentrations of oxygen Patient with ventilatory impairment requiring assisted ventilation Contraindications: Lack of training in technique Lack of proper indications

Endotracheal Intubation Complications: Hypoxemia from prolonged intubation attempts Trauma to the airway with resultant hemorrhage Right main stem bronchus intubation Esophageal intubation Vomiting leading to aspiration Loose or broken teeth Injury to the vocal cords Conversion of cervical spine injury to one with neurological deficit

Endotracheal Intubation Verification of ETT placement: Direct visualization of ETT passing through vocal cords Presence of bilateral breath sounds and absence of air sounds over epigastrium Visualization of chest rising and falling during ventilation Fogging in ETT on expiration

Endotracheal Intubation Verification of ETT placement adjunct devices: Esophageal detector devices Colorimetric Co2 detector End-tidal Co2 monitoring (capnography) Pulse oximetry

Larngeal Mask Airway It is designed for blind insertion Can be reused multiple times Disposable ones are now available It is available in a range of sizes

Larngeal Mask Airway Indications: Contraindications: Complications: When unable to perform ET intubation and the patient cannot be ventilated with BVM Contraindications: When ET intubation can be performed Insufficient training Complications: Aspiration Laryngiospasm

Surgical Cricothyrotomy Indications: Massive mid-face trauma precluding the use of BVM device. Inability to control the airway less invasive maneuvers. Ongoing tracheo-broncheal hemorrhage

Surgical Cricothyrotomy Contraindications: Any patient who can be safely intubated. Patients with laryngotracheal injuries Children under 10 years of age Patients with acute laryngeal disease of traumatic or infectious origin Insufficient training

Surgical Cricothyrotomy Complications: Prolonged procedure time Hemorrhage Aspiration Misplacement or false passage of ETT Injury to the neck structures or vessels Perforation of the esophagus

Ventilatory Devices and Oxygen Concentration Without Supplemental Oxygen Flow (L/Min) Oxygen Concentration Mouth to mouth NA 16 % Mouth to mask Bag-valve-mask 21 %

Ventilatory Devices and Oxygen Concentration With Supplemental Oxygen Flow (L/Min) Oxygen Concentration Nasal Cannula 1 – 6 24 – 45 % Mouth to mask 10 50 % Simple face mask 8 – 10 40 – 60 % BVM without reservoir BVM with reservoir 10 – 15 90 – 100 % Nonrebreathing mask with reservoir Ventilator NA 21 – 100 %