Artificial airway

Artificial Airways

Oropharyngeal Airway (OPA)

  • Purpose: Relieves upper airway obstruction by maintaining space at the back of the throat.

  • Functions:

    1. Acts as a bite block for patients having seizures to prevent tongue lacerations.

    2. Supports suctioning during emergencies.

    3. Prevents occlusion of the endotracheal (ET) tube during intubation.

    4. Used with Bag-Valve-Mask (BVM) for manual ventilation/resuscitation.

  • Patient Considerations:

    • Poorly tolerated by conscious patients due to gag reflex, risk of vomiting or aspiration.

    • Requires head tilt for proper placement.

  • Types:

    • Berman: Features grooves on the side, more rigid.

    • Guedel: A hole in the middle, more flexible.

  • Sizes: Available in a variety of sizes.

  • Placement Technique:

    • Can be inserted upside down (180 degrees) or from the side (90 degrees).

    • Measured from corner of the mouth to the tragus of the ear.

Nasopharyngeal Airway (NPA)

  • Purpose: Facilitates nasal suctioning and provides a patent airway.

  • Advantages:

    • Better tolerated by conscious patients with an active gag reflex.

  • Maintenance:

    • Alternate nostrils every 8-24 hours to prevent complications:

      • Sinus blockage, sinusitis, necrosis.

    • Ensures better oval cavity access.

  • Types:

    • Nasal Trumpet: Pliable design.

    • Rusch Tube: Straight red rubber design.

  • Placement Technique:

    • Apply sterile lubricant.

    • Measure from the tip of nares to the lip, gently insert.

Esophageal Obturator Airway (EOA)

  • Purpose: Inserted into the esophagus to provide emergency airway access by field personnel (EMTs, paramedics).

  • Process:

    • EOA is used temporarily until an ET tube can be placed.

  • Hazards:

    1. Vomiting and aspiration upon removal.

    2. Risk of esophageal rupture from over-distention.

    3. Inadvertent intubation of the trachea leading to asphyxiation and death.

Cricothyrotomy

  • Indication: Emergency procedure for acute upper airway obstruction when intubation fails.

  • Procedure:

    • Puncture or incision through the cricothyroid membrane (below vocal cords).

  • Tools:

    • Requires a large gauge needle with a barrel to aspirate air before insertion.

  • Complications:

    • Potential perforation of the thyroid or esophagus.

Intubation

Oral Endotracheal Tubes (ETTs)

  • Purpose: Provide an artificial airway for emergency situations.

    1. Best for short-term intubation (less than 24 hours).

    2. Supports mechanical ventilation and CPAP (Continuous Positive Airway Pressure).

    3. Relatively easy to insert, usually replaced with a trach tube after 7-21 days.

  • Advantages:

    1. Easier insertion for emergency intubation.

    2. Larger tube size than nasal ETT reduces resistance.

    3. Avoids sinus issues (sinusitis, otitis media).

    4. Easier suctioning and decreased work of breathing.

  • Hazards:

    1. Poorly tolerated in conscious patients.

    2. Difficult to stabilize leading to self-extubation risks.

    3. Potential for tube obstruction due to biting.

    4. Oral hygiene challenges and inability to speak/eat.

    5. Increased risk of mainstem intubation and injury to oral structures.

Nasal Endotracheal Tubes (ETTs)

  • Purpose: Protects against aspiration, provides airway for mechanical ventilation or CPAP.

  • Advantages:

    1. More comfortable for longer durations.

    2. Lower risk of mainstem intubation compared to oral ETTs.

    3. Better oral hygiene and stabilization of the tube.

    4. Less salivation and improved swallowing of secretions.

  • Hazards:

    1. Potential necrosis from pressure.

    2. Sinus drainage obstruction.

    3. Difficulties performing bronchoscopy.

    4. Increased airflow resistance and potential kinking.

Laryngeal Mask Airway (LMA)

  • Purpose: Inserted into the larynx to provide ventilation with low pressures; typically for short-duration surgeries.