Endotracheal Intubation

Endotracheal intubation is indicated if the chin liftjaw thrust maneuver fails to establish or secure a patent airway, if the patient is obtunded and aspiration is a concern, if positive-pressure mechanical ventilation is required, if tracheobronchial secretions cannot be cleared, or if complete control of the airway is desirable. In critically ill patients, use of the esophageal obturator airway and its variants should be limited to situations in which endotracheal intubation has been unsuccessful and no other methods are available. Any maneuver involving movement of the neck should be avoided in cases of confirmed or suspected cervical spine injury. However, if the patient sustains apnea or severe hypoxemia despite conservative management, immediate endotracheal intubation may become necessary. Oral endotracheal intubation may be attempted if stability of the neck can be maintained. The risk of further damage must be balanced by the overall risk to the patients life owing to failure to secure an airway. If time permits, fiberoptic nasotracheal intubation should be the first choice in such situations. Blind nasotracheal intubation is the alternative when a skilled operator with the necessary equipment for fiberoptic intubation is not available or when the oral approach is contraindicated, impossible, or difficult. Nevertheless, a careful orotracheal approach is common practice.