ENDOTRACHEAL

3. Gloves
4. Oral Suction Catheter
INTUBATION 5. Lubricating Jelly
6. 10mL syringe
 The placement of a tube into the trachea 7. Stethoscope
(windpipe) in order to maintain an open 8. Checked and working ventilator
airway in patients who are unconscious or
unable to breathe on their own.
 Intubation should only have limit of 20
seconds per attempt of placement. Beyond
that, the placement of intubation is more
bloody.

Technique to lift the Laryngoscope to

expose Larynx
the operator should visualize the epiglottis and
place the blade tip in the vallecula. Applying
firm, steady upward pressure at a 45-degree
angle, the curved laryngoscope is used to lift the
epiglottis and expose the vocal cords.

Endotracheal Tube Stylets

INDICATION
 Respiratory arrest
 Respiratory failure
 Airway obstruction
 Hemorrhage with poor perfusion
 Pulmonary contusion
 Multiple trauma, head injury, and
abnormal mental status
 Inhalation injury with edema of vocal
cords

ARTICLES REQUIRED FOR

INTUBATION
1. Laryngoscope
2. Ambu bag
Confirmation of ET Placement  Blockage of endotracheal tube with
1. Visualization secretions
2. Auscultation  Nosocomial respiratory infection
3. ETCO2  Palatal groove formation
4. Chest X-ray (CXR)  Acquired cleft palate, and defective primary
dentition
Confirming ET tube placement  Acquired subglottic stenosis
Correct placement
 ETCO2 (End Tidal Carbon Dioxide) - the
recommended method
Extubation
Signs
 Bilateral breath sounds Extubation
 Equal breath sounds  Extubation refers to removal of the
endotracheal tube (ETT). It is the final step
 Rise of the chest with each ventilation
in liberating a patient from mechanical
 No air heard entering stomach ventilation.
 No gastric distention  At the end of the weaning process, it may be
 Confirmation of tip position in trachea apparent that a patient no longer requires
 Chest X-ray tip at T2 mechanical ventilation to maintain sufficient
ventilation and oxygenation. However,
Tube in Right Main Bronchus extubation should not be ordered until it has
 Breath sounds only on right chest been determined that the patient is able to
 No air heard entering stomach protect the airway and the airway is patent.
 No gastric distention Airway Protection
Airway protection is the ability to guard against
Action: Withdraw the tube, recheck aspiration during spontaneous breathing. It
requires sufficient cough strength and an
Tube in esophagus adequate level of consciousness, each of which
 No breath sounds heard should be assessed prior to extubation. The
 Air heard entering stomach amount of secretions should also be considered
 Gastric distention may be seen prior to extubation because airway protection is
 No mist in tube significantly more difficult when secretions are
 No CO2 in exhaled air increased.
Action: Remove the tube, oxygen the infant Criteria for Extubation
with a bag and mask, reintroduce ET tube. 1. Hemodynamically stable
 No dysrhythmias
Complications  Minimal inotrope requirements
 Hypoxia
 Bradycardia Examples of inotropic drugs: dopamine,
 Apnea epinephrine, norepinephrine
 Pneumothorax
 Soft tissue injury  Optimal fluid balance
 Infection 2. Adequate ventilation deoxygenation
 Pharyngeal esophageal and tracheal trauma  FIO2 < 0.5
or perforation  Vital Capacity of > 10 ml/kg
 Cardiorespiratory instability during intubation  Tidal volume > 5ml/kg
attempts  Respiratory rate < 25 BPM
 Accidental extubation 3. Arterial Blood Gas
  PCO2 < 6 kPa
 PO2 > 8 Kpa ON FIO2 of 40% and PEEP5
 PH with a normal range (7.35 – 7.45)
4. Others
 Sedating agents must be stopped for >
24 hours
 Causative condition resolved/under
control
 Paralyzing agents stopped > 24 hours
 Normal metabolic status. Electrolyte
balance must be normal
 Patient must be neurologically intact.
Awake, well-motivated, follows verbal
commands and intact gag/cough reflex
 Take into consideration aspiration risk
and airway edema
Evaluation
 Assess air entry and respiratory status
 Auscultate the chest for breathing sounds
and for the presence of secretions
 Do vital observations
 Remain with the patient to determine
respiratory stability
 Obtain arterial blood gas within the next hour
Record Keeping
 Tidy up after the procedure
 Wash hands
 Record all actions taken and chart vital signs
on observation chart

Intubation Explained (YOUTUBE)

 Most common airway management
 Insertion of flexible tube (ETT) through vocal cords and into patient’s trachea
ROUTES:
 Mouth (orotracheal)
 Nose (nasotracheal)
This allows us to control patient’s airway
 Ensures open airway
 Control ventilation and oxygenation through ventilator and bag valve mask
o Having endotracheal tube in place: better control over volume of breath, frequency, and FIO2
 Protect from aspiration

Intubation is invasive and uncomfortable.

Why intubate?
1. Protect airway
2. Ventilate
3. Oxygenate

Indication
Other examples needing ETT in place: Esophagogastroduodenoscopy (EGD), Trans-esophageal
echocardiography (TEE), Bronchoscopy

Contraindication

Complications
VAP – Ventilator-acquired pneumonia