Escolar Documentos
Profissional Documentos
Cultura Documentos
• Endotracheal intubation (ET intubation) involves the placement of a tube into the trachea
via the mouth or nose past the larynx.
• Indications for ET intubation include (1) upper airway obstruction (e.g., secondary to burns,
tumor, bleeding), (2) apnea, (3) high risk of aspiration, (4) ineffective clearance of
secretions, and (5) respiratory distress.
• A tracheotomy is a surgical procedure that is performed when the need for an artificial
airway is expected to be long term.
• Oral ET intubation is the procedure of choice for most emergencies because the airway can
be secured rapidly, a larger diameter tube can be used thus reducing the work of breathing
(WOB) and making it easier to remove secretions and perform fiberoptic bronchoscopy.
• Before intubation is attempted, the patient is preoxygenated using a self-inflating BVM with
100% O2 for 3 to 5 minutes.
o Each intubation attempt is limited to less than 30 seconds. If unsuccessful, the
patient is ventilated between successive attempts using the BVM with 100% O2.
• Following intubation, the cuff is inflated, and the placement of the ET tube is confirmed
while manually ventilating the patient with 100% O2.
o An end-tidal CO2 detector is to confirm proper placement by measuring the amount
of exhaled CO2 from the lungs.
The detector is placed between the BVM and the ET tube and either observed
for a color change (indicating the presence of CO2) or a number.
If no CO2 is detected, than the tube is in the esophagus.
o The lung bases and apices are auscultated for bilateral breath sounds, and the chest is
observed for symmetric chest wall movement.
o A portable chest x-ray is immediately obtained to confirm tube location (3 to 5 cm
above the carina in the adult).
• ABGs should be obtained within 25 minutes after intubation to determine oxygenation and
ventilation status.
MECHANICAL VENTILATION
• Mechanical ventilation is the process by which the fraction of inspired oxygen (FIO2) at
21% (room air) or greater is moved into and out of the lungs by a mechanical ventilator.
• Indications for mechanical ventilation include (1) apnea or impending inability to breathe,
(2) acute respiratory failure generally defined as pH ≤ 7.25 with a PaCO2 ≥50 mm Hg, (3)
severe hypoxia, and (4) respiratory muscle fatigue.
• Positive pressure ventilation (PPV), used primarily with acutely ill patients, pushes air into
the lungs under positive pressure during inspiration. Expiration occurs passively as in
normal expiration. Modes of PPV are categorized into two groups:
o Volume ventilation involves a predetermined tidal volume (VT) that is delivered
with each inspiration, while the amount of pressure needed to deliver the breath
varies based on the compliance and resistance factors of the patient-ventilator
system.
o Pressure ventilation involves a predetermined peak inspiratory pressure while the
VT delivered to the patient varies based on the selected pressure and the compliance
and resistance factors of the patient-ventilator system.
• Careful attention must be given to the VT to prevent unplanned
hyperventilation or hypoventilation.