Tracheal intubation: technique, features and consequences
Intubation today is the main method of ensuring the airway during the operations under and resuscitation. The essence of this procedure is the introduction of a special tube into the patient’s throat. Despite the large number of external epiglottic instruments, only intubation is still the most reliable and proven method.
Indications for intubation
Tracheal intubation is a procedure that allows the patient to maintain a stable airway. All medical teams should have the skills to perform such an operation, since its implementation is often required before hospitalization.
Tracheal intubation is necessary during resuscitation, airway obstruction, and endotracheal anesthesia. At the same time in medical practice there are a number of basic indications for such a procedure. It is customary to divide them into absolute and relative.The decision is made by the attending physician or ambulance team.
Indications for intubation (absolute):
- Traumatic brain injury.
- Aspiration syndrome.
- Pulmonary cardiopulmonary resuscitation.
- Deep coma.
- Obstruction of the airways.
Relative indications for intubation:
- State of shock.
- Pulmonary edema.
- Thermal inhalation injuries.
- Pulmonary insufficiency.
The decision on tracheal intubation is made by the doctor individually, based on the patient’s condition and the reasons for the emergence of his emergency.
Contraindications to the procedure
Before performing a difficult manipulation, the doctor must make sure that the patient has no contraindications for tracheal intubation.
Reasons for not conducting the procedure:
- Laryngeal edema.
- Swelling of the tongue.
- Throat swelling.
- Tracheal trauma.
- Changes in the structure of the organs of the neck or skull, which are pathological or traumatic.
If the intubation is carried out in a planned manner, that is, the patient is prepared for the operation in advance, then the anesthesiologist first examines the patient and studies the history of his illness. Just making sure that the procedure does not cause complications, the doctor decides to conduct it.
Instruments required for intubation
In order for the procedure to be successful, the medical staff must possess certain skills and have the tools (trachea intubation kit). Equipment is introduced into the upper airways, the technique of these actions will be discussed below.
A tracheal intubation kit should include:
- Laryngoscope. A medical instrument that allows you to improve the visualization of the larynx during the procedure. Experts recommend using a device with a curved tip, which only increases the review.
- Trocar. Special tool (surgical), with which penetration into the body cavity is provided.
- Surgical clamp. It is a metal scissors. Used to cleanse the mouth of viscous secretions.
- Vent bag. It looks like a rubber pear that connects to the tube. With the help of this device is mechanical ventilation.
- Endotracheal tubes. Thermoplastic thin tubes that are inserted into the larynx. After the introduction, they have the property of increasing in size, which allows creating the conditions necessary for the procedure.
- Catheter and aspirator. These are sanitation tools that are used to clear the trachea from secretions and other liquid accumulations.
Medical practice shows that in emergency situations, in the period before hospitalization, it is difficult to achieve optimal conditions for tracheal intubation. At such moments, it is important to clearly know the basic rules of the procedure.
Intubation can be performed by two main methods:
- Intubation by mouth.
- Nasotracheal method.
The first method is considered the most common, as it allows you to get more control over the procedure. It is important to remember that the patient should be as relaxed as possible. In general anesthesia, this is achieved after anesthesia; in emergency situations, drugs from the category of relaxants are used.
The position of the patient's body should be horizontal. Under the neck enclose the roller, which allows for its maximum alignment.
The tracheal intubation algorithm is as follows:
- It is necessary to achieve maximum relaxation of the patient, enter it into anesthesia.
- Conducted artificial lung ventilation using an oxygen mask (about 2-3 minutes).
- The resuscitator opens the patient's mouth and inserts a laryngoscope there.
- The tool is pressed against the root of the tongue, which ensures better accessibility of the larynx.
- The doctor inserts a thermoplastic tube into the pharynx.
An error in the technique of tracheal intubation may pendants in the patient's hypoxia or to other complications. Depending on the situation, the doctor repeats the attempt, or refuses from this method of ventilation.
Intubation of babies
Intubation of newborns is a procedure quite common in medical practice. In some cases, this is the best way to establish a stable lung function. However, the procedure must be carried out with extreme caution.
In the case of babies, intubation is not performed through the mouth, but through the nasal passage. Before you enter the tube, its surface is smeared with a special cream.
An intubated child must be under the watchful supervision of medical personnel until its own respiratory function is improved. After that, the tubes are carefully removed.
Possible consequences and complications
Adverse effects and complications arise mainly due to incorrect technique of the procedure.Such a state of affairs may be a consequence of insufficient competence of medical personnel or unfavorable conditions for intubation.
Among the possible consequences are the following:
- Traumatic injuries (mandibular trauma, broken teeth, mucosal damage, laryngeal trauma).
- Complications of a technical nature (tube displacement, tube obstruction, tube getting into the right bronchus).
- The effects of intubation under general anesthesia become noticeable later. Such complications include swelling of the vocal cords, laryngitis, the granuloma of the vocal cords.
Modern medical statistics show that today it is difficult to get complications from tracheal intubation. The medical staff has the necessary knowledge and skills and has the right tools available.