air management (unit 8 LAB)

Primary Airway Functions

• Upper Airways: Warm, filter, and humidify inspiratory gases; prepare the air for gas exchange.

• Lower Airways: Conduct gas exchange at the alveolar level.

• Diaphragm: Acts as a mechanical pump for air movement in and out of lungs.

• Indications for Artificial Airways: Unable to support proper ventillation; foreseeable impediment in ventilation status.

Airway Compromise

• Loss of one or more primary airway functions:

  • Inability to adequately ventilate.

  • Need to relieve airway obstruction.

  • Facilitate removal of secretions.

  • Airway Protection: Prevent aspiration (inhalation of foreign matter into lungs).

    • Aspiration: Introduction of liquids or food into the lungs instead of the esophagus.

  • Loss of motor function and change in consciousness level increases risk of aspiration.

Non-Invasive Ventilation Procedures

• Bag-Valve-Mask Devices (BVMs):

  • Used for short-term ventilation in emergencies or during transport.

  • Positive pressure ventilation delivered non-invasively.

  • Oxygen flow input should be set between 10-15 liters per minute (preferably at 15 liters).

  • Ensure the bag is adequately inflated and not collapsing during use.

  • Deliver appropriate tidal volume slowly over one second to maintain proper inspiratory-expiratory (IE) ratios.

• Risks: Rapid pressure can cause hyperinflation and barotrauma.

Establishing Airway Management

• If patient requires ongoing ventilation: consider other non-invasive methods (BiPAP, CPAP).

• Pharyngeal Airways:

  • Types: Nasopharyngeal and oropharyngeal airways.

    • Nasopharyngeal Airway: Reduces trauma to nasal mucosa during suctioning; used for frequent nasotracheal suctioning.

    • Oropharyngeal Airway: Only for unconscious patients; prevents tongue obstruction and allows suctioning.

Endotracheal and Tracheostomy Airway Management

• Endotracheal Tubes (ET): Inserted via mouth/nose to trachea; intubation is the process of placement.

• Tracheostomy: Surgically inserted airway bypassing upper airway to facilitate ventilation and secretions clearance.

  • Key Points:

    • Use pilot balloon to manage cuff integrity.

    • Sizing for ET tubes based on patient age/height; typically sized to pinky diameter.

    • Pediatric sizing: age in years divided by 4 plus 4 for uncuffed; plus 3 for cuffed.

Intubation Process

• Required Equipment:

  • Suction setup, BVM, oropharyngeal airways, laryngoscope, endotracheal tube, securing device, and local anesthetics.

• Positioning: Align patient's mouth, pharynx, and larynx to visualize glottis, ensuring airway is patent.

• Technique: Use laryngoscope to depress tongue and lift epiglottis; insert ET tube beyond vocal cords.

  • Confirm placement through capnography and auscultation of breath sounds.

Troubleshooting Intubation

• Common issues post-intubation:

  • Displacement: Unilateral breath sounds indicate right mainstem intubation.

    • Adjust tube position.

  • Obstruction: Kinking, mucus plug, or distortion in airflow.

    • Remove/clean inner cannula if necessary.

Tracheostomy Details

• Indications: Prolonged ventilation, bypassing upper airway obstruction.

• Procedure: Can be performed bedside or in OR; requires careful anatomical consideration.

  • Complications: Include bleeding, pneumothorax, and tube displacement.

• Types of Tracheostomy Tubes: Single or double cannula, cuffed or cuffless, fenestrated.

  • Cuff Management: Inflate to maintain airway seal; assess for leaks to ensure effective ventilation.

Goals and Care

• Maintain adequate airway, provide communication, ensure humidification, limit infections, facilitate secretions clearance, and manage cuff pressures to minimize trauma.