Airway equipments for Anaesthesia

Masks, Supraglottic Airways and Airway adjuncts
Sealing face masks
Magill forceps
Guedel airways
Nasopharyngeal airways
Bite blocks
 Laryngeal mask airways
Bougies, stylets and airway exchange catheters
• Laryngoscopes
Direct vision laryngoscopes
Rigid indirect laryngoscopes
Fibreoptic endoscopes for intubation.
• Endotracheal tubes and related equipment
 Endotracheal tubes
Double lumen endobronchial tubes .
• Infraglottic airways
Tracheostomy tubes

1. Airway
Equipment's
Mr. Harshad Khade
MSc. Medical Technology (OTA)
Symbiosis International university, Pune.

2. Airway Equipment
•Masks, SupraglotticAirways and Airway adjuncts
Sealing face masks
Magill forceps
Guedelairways
Nasopharyngeal airways
Bite blocks
Laryngeal mask airways
Bougies, stylets and airway exchange catheters

3. •Laryngoscopes
Direct vision laryngoscopes
Rigid indirect laryngoscopes
Fibreopticendoscopes for intubation.
•Endotracheal tubes and related equipment
Endotracheal tubes
Double lumen endobronchialtubes .
•Infraglotticairways
Tracheostomy tubes

4. Masks, SupraglotticAirways
And Airway Adjuncts

6. Sealing Face Masks
•Face masks have a soft seal that fits over the patient’s nose and mouth.
•The seal permits Non-invasive positive pressure ventilation, and allows
effective administration of 100% oxygen.
The breathing system is usually attached to the mask via a Catheter mount and
90°angle piece.
This angle piece attaches to the mask via a standard 22mm connector.
The mask is designed to seal to the face using either an inflatable air cushion
or a silicone seal.
Pediatric masks may have a pleasant scent to improve patient acceptance.

7. •Advantages
A sealing face mask allows 100% oxygen to be delivered using an appropriate
breathing system.
A face mask is the simplest method of applying positive pressure ventilation and its
use is an essential component when managing respiratory or airway emergencies.
•Disadvantages
Achieving a seal may prove difficult in some patients, particularly the edentulous..
Claustrophobia is a significant problem in some patients. This problem is improved
by modern transparent masks.
•Safety
Mask use can cause pressure injuries. Both skin breakdown and facial and
trigeminal nerve injury have been reported, usually after prolonged Non
Invasive Positive pressure Ventilation. (NIPPV)

9. Magill Forceps
•Magill forceps are shaped to enable manipulation of objects within the
oropharynx without the operator’s hand being in the line of sight.
•Originally designed to aid placement of bougiesinto the larynx, Magill
forceps are commonly used to manipulate all manner of objects, including
tracheal tubes, nasogastric tubes, throat packs, reinforced laryngeal mask
airways and foreign bodies.
•They are essential for safe practice and should be immediately available
during every anesthetic.
•The forceps are available in adult and pediatric sizes.
•The curved design allows the anaesthetist’shand to be out of the line of vision
when used within the tight confines of the oropharynx.

10. •Advantages
Facilitates manipulation of objects within the oropharynx.
Positions hand out of line of sight.
•Disadvantages
Potential to cause trauma.
•Safety
Care should be taken to avoid damaging the cuff on the
endotracheal tube, and to avoid oral trauma, particularly to the
uvula.

12. GuedelAirways
•The terms ‘oropharyngeal airway’ and ‘Guedelairway’ are usually used
interchangeably to describe the airway adjunct designed by American
anesthesiologist, Arthur Guedel.
•Used in unconscious patients to improve upper airway patency.
•In an anaestheticsetting, Guedelairways may be used prior to the
insertion of, or after the removal of, a more definitive airway.
•They are also used in emergency situations by other health
professionals who do not have advanced airway skills

14. •A Guedelairway maintains upper airway patency by keeping the mouth
open and preventing the tongue falling backwards.
•The airway is available in a range of sizes from neonate to adult.
•To determine the correct size, the airway is held up to the patient’s face.
•The size that is most appropriate for the patient can be estimated in two
ways: either the ‘hard-to-hard’ method, where the flange is placed at the
level of the incisors and the tip at the angle of the mandible, or the ‘soft-
to-soft’ method, from the angle of the mouth to the tragus of the ear.
•In adults, the Guedelis usually inserted upside down and then rotated
180 degrees once it has reached the back of the oropharynx.

16. •Advantages
•The airway is simple and easy to use and is available in all clinical
areas.
•All healthcare professionals should be familiar with its use.
•Disadvantages
•Guedelairways are poorly tolerated by semi-conscious patients
and they may induce vomiting.
•Blind insertion of a Guedelmay cause bleeding, especially from
upper airway tumors.
•Incorrect sizing may cause obstruction:-
too long, and it may push the epiglottis over the laryngeal inlet.
too short, and it will not pass the base of the tongue.

18. Nasopharyngeal Airways
•The nasopharyngeal airway adjunct is used as an alternative to an
oropharyngeal airway.
•It is most commonly used in emergency situations, but may be used in
anaesthetized patients who have poor mouth opening.
•It is also sometimes used to facilitate regular suctioning of the
oropharynx using a suction catheter.
•The airway is traditionally sized by matching its diameter with that of
the patient’s little finger.

20. •Advantages
•Tolerated in semi-conscious patients.
•Suctioning can take place through the nasopharyngeal tube.
•Disadvantages
•Contra-indicated when there is deranged coagulation.
•Safety
•The potential risk of intracranial placement of the airway in cases of
basal skull fracture must be balanced with the need to maintain an
airway.

22. Bite Blocks
•A roll of gauze between the molars has traditionally been improvised
by anaesthetistsfor the purpose of preventing patients obstructing
their airway by biting the endotracheal tube
•These devices prevent patients from biting down and obstructing
airway devices during emergence from anaesthesiaand sedation.
•The Breathe safe Bite Block may also aid emergency reintubation or
the insertion of a laryngeal airway by keeping the mouth open whilst
situated in a lateral position within the mouth

23. •Advantages
•Reduces the risk of dental damage when compared to the use of
Guedelairways for this purpose.
•Positioned laterally between the incisors, allowing instrumentation
of the airway.
•Disadvantages
•The T-shaped handle and anti-swallow flange may hinder
conventional bag mask ventilation.

25. Laryngeal Mask Airways
•The original laryngeal mask airway (LMA Classic, Teleflex Inc.) was
introduced in 1988 by the British anesthetist, Dr. Archie Brain.
•It is a reusable device and may be steam autoclaved 40 times.
•LMAs are most commonly used for airway management in fasted
patients who do not suffer from significant gastro-oesophagealreflux.
•They may also be used as an emergency airway where a practitioner
skilled in intubation is not available or as an emergency airway in
‘can’t intubate, can’t ventilate’ situations.

27. Technique For Inserting LMA
•The technique for insertion as described by DrBrain follows.
•Prepare the LMA by fully deflating the cuff, apply water-soluble gel to
the back of the cuff.
•Hold the LMA like a pen, with the index finger placed anteriorly at the
junction of the cuff and tube

28. •Push the mask backwards along the hard palate. As the mask moves
downwards, the index finger maintains pressure backwards against the
posterior pharyngeal wall to avoid collision with the epiglottis
•Insert the index finger fully into the mouth to complete insertion,
stopping when resistance is felt.
•Inflate the cuff without holding the tube or connecting the breathing
system. When correctly positioned, the LMA will be seen to rise
slightly in the mouth.
•The manufacturers recommend using a bite block with the LMA
Classic.

29. •Advantages
Advantages common to all sealing supraglotticairways
•Neuromuscular blocking drugs are not required.
•Insertion requires less skill than intubation.
•There is minimal hemodynamic response to insertion and removal (cf.
endotracheal intubation).
•Emergence is smooth, which is particularly useful in head and neck
surgery.
•Disadvantages
Disadvantages common to all sealing supraglotticairways
•Achieving an adequate seal is not possible in a small proportion of
patients.
•There is a risk of aspiration of gastric contents –it is not a ‘definitive
airway’.
•They may cause laryngospasm.

31. I-gel
•The i-gel has a non-inflatable cuff made of an anatomically shaped
elastomer gel which further mouldsto the airway shape when it warms
to body temperature.
•It seals to around 25 cmH2O.
•A thin coating of lubricant should be applied to all sides of the device
before insertion.

32. •Advantages
•Integrated gastric drain tube.
•Integrated bite block.
•Simple insertion without inserting hand into patient’s mouth.
•No cuff to inflate.
•Improved stability in edentulous patients.
•Disadvantages
•Bulky –oral surgery is impossible.
•Lower pharyngeal and oesophageal seal pressures compared with
the LMA Proseal.

33. Bougies, Stylets And
Airway Exchange
Catheters

35. Bougies
•The original Portexbougiewas 60 cm long with a 5mm diameter and an
angled ‘Coude’ tip.
•It was reusable and made of beige resin over fiberglass, which allowed it to
retain some of its shape when bent.
•Newer designs are available from a variety of manufacturers and are often
single use.
•When in use, the tip is angled anteriorly and can be used to identify tracheal
rings that may be felt as ridges on insertion, in contrast to the smooth
oesophagus.
•Adult (15 Fr) and pediatric (10 Fr) Bougiesare available.

36. •Uses
•To facilitate tracheal intubation.
•For airway exchange (ETT or tracheostomy).
•During emergency surgical Crico-thyroidotomy.
•Advantages
•The narrow diameter allows superior visualization of the airway anatomy
in comparison to an ETT.
•Angled tip to identify tracheal rings.
•Some shape retention, so can be curved to shape.
•Disadvantages
•Size 4.0 ETT minimum (paediatric bougie).

37. Guides
•A guide is a bougiewith a straight tip. It is used only for airway
exchange so its ability to retain shape is much less important and the
angled tip is unnecessary because the tube being exchanged is
already in the trachea.
•Uses
•Airway exchange.
•Advantages
•Sizes available down to 1.7 mm outer diameter, thus allowing use
with pediatric tubes.
•No resistance from straight tip on inserting or removing
endotracheal tube.

39. Stylets
•Stylets are placed within an ETT prior to intubation and used to hold
the tube in a particular shape.
•They are made of polyethylene with an aluminum core.
•The proximal end is curved over to prevent the stylet migrating distally.
•The tip of the stylet must remain proximal to the tip of the tube to
prevent airway trauma.

40. •Uses
•Available for To add rigidity and shape to ETTs.
•Advantages
•all sizes of tube.
•Retains its shape fully and stiffens the ETT.
•Disadvantages
•Potential for airway trauma

42. Laryngoscopes
Direct vision laryngoscopes
Rigid indirect laryngoscopes
Fibreopticendoscopes for intubation.

44. Direct Vision Laryngoscope
•A direct vision laryngoscope is a device for viewing the larynx. It
consists of a handle and a blade and is designed with a light to
illuminate the tip.
•Uses
•Tracheal intubation.
•Visualization of the larynx and pharynx for foreign body removal or
suctioning.
•Placing of nasogastric tubes, throat packs and other devices.

46. Technique For Curved Blade Laryngoscopy
•Position patient with the neck flexed and the atlanto-occipital joint extended. In an
ideal position, the external auditory meatus should be in the same horizontal plane
as the sternal notch.
•Insert blade along the right side of the mouth until it reaches the back of the tongue.
•Sweep the tongue to the left to provide a sight line down the center of the mouth.
•Advance the laryngoscope under direct vision until it rests in the vallecula.
•Lift the epiglottis with the force applied in line with the axis of the laryngoscope
handle. Avoid excessive leverage of the handle backwards as this may worsen the
view and break the patient’s teeth.
•Visualize the glottis and advance the tube in from the right side of the mouth so as to
maintain your view.

47. •Advantages
•Simple and widely available.
•Wide range of blades and handles.
•Success rate for intubation over 99% with experienced operators.
•Disadvantages
•Direct laryngoscopy is a skilled technique –success rate plateaus
after around 50 intubations.
•It is difficult to teach because trainee and trainer cannot
simultaneously see the same view.
•Direct line of sight to the glottis is impossible to achieve in some
patients.

49. Laryngoscope Blades
Macintosh
•The curved blade is designed with a large reverse-Z shaped flange to
sweep the tongue to the left of the mouth.
•The tip is placed in the vallecula, indirectly lifting the epiglottis via
pressure on the hyo-epiglotticligament.
•The light source pierces the blade towards the tip so as nottointerfere
with the view. Left-handed Macintosh blades are available for use in
patients with rightsidedfacial deformities.

51. Miller
•The miller is the most commonly used straight blade.
•It is also manufactured in neonate to adult sizes, though the adult designs
are rarely used.
•The small flange does not permit a tongue sweep; instead the blade is
directed along the right side of the mouth and the tip re-angled once it
has passed the base of the tongue.
•In contrast to the standard curved blade technique, the tip of a straight
blade is placed over the epiglottis lifting it directly.
•Straight blades are particularly useful in neonates and infants because of
the relatively large epiglottis.

53. McCoy
•The McCoy is a modification of a Macintosh blade. Its design allows the tip
to be flexed (using the lever alongside the handle) in order to lift the
epiglottis without the degree of force that would be required using a
standard blade.
•It makes some difficult intubations easier and is commonly found on
difficult airway trolleys.

55. Polio Macintosh
•A modification of the Macintosh design with the blade mounting on the
handle at 135°rather than 90°.
•This allowed it to be used in polio patients being ventilated in an iron lung
which would otherwise obstruct the handle.
•It now finds occasional use in patients with restricted neck mobility or
large breasts, sometimes in conjunction with a stubby handle.

57. Rigid Indirect Laryngoscopes
•Rigid indirect laryngoscopes (RILs) allow visualization of the larynx by
a means other than direct line of sight, using a combination of mirrors,
prisms, fibreoptic
•Uses
•RILs may be used for any intubation, but are especially useful for
difficult intubations, where the larynx is anterior, neck extension is
limited or there are upper airway abnormalities.
•RILs are also now finding a use in awake intubation following local
anaesthesiato the airway s or video cameras.

58. •Advantages
•RILs convert some difficult intubations into easy intubations.
•The reduced lifting force during laryngoscopy (because the oral and pharyngeal axes
do not need to be aligned) minimizes the hemodynamic
•Cervical spine movement may be minimized.
•Airway trauma may be reduced because of improved vision (fewer blind attempts).
•It is easier to teach than direct laryngoscopy since trainee and trainer can usually both
see the same image.
•Disadvantages
•It is often possible to obtain an excellent view but then find it difficult to pass the tube.
•Better mouth opening is required than for flexible fibrotic intubation.
•Cost.
•Blood and secretions may significantly impair the view

60. FibreopticEndoscopes For Intubation
•Fibreopticendoscopes rely on total internal reflection to transmit light to, and
an image back from, the tip of a flexible insertion cord.
•The tip may be angled in order to steer the scope into position.
•The image may be viewed on an eyepiece or transmitted onto a screen.
•Uses
•Awake intubation, particularly in patients with a difficult airway.
•To check the position of ETTs For placement of bronchial blockers
•To guide percutaneous tracheostomy
•Suctioning and pulmonary toilet.
•Diagnosis of upper airway pathology

62. •Advantages
•A fibreopticscope permits visualization of the airway beyond the glottis. ⦁It
may facilitate intubation, particularly in patients with difficult oropharyngeal
anatomy.
•Once the insertion cord is correctly positioned, the ETT is railroaded into
position
•Permits pulmonary suction under direct vision.
•Disadvantages
•Fibreopticbronchoscopy and intubation are skilled techniques.
•Blood or secretions in the airway will obscure the view.
•Passing an endoscope may cause complete airway obstruction in patients
with a critically narrowed airway
•The equipment is expensive and fragile.
•Decontamination is required after each use.

63. Endotracheal Tubes And
Related Equipment
Endotracheal tubes
Double lumen Endo-Bronchial tubes .

65. Endotracheal Tubes
•The cuffed oral endotracheal tube (COETT) is the most commonly used ETT
and is covered fi rst. Other types of ETT are then compared.
•COETTs are used to secure the airway, allowing spontaneous or controlled
ventilation while reducing the risk of aspiration.
•They are used in Anaesthesia, resuscitation and critical care situations.
•Modern tubes are single use and made of clear polyvinyl chloride (PVC),
whereas the original designs used sterilizablerubber.

66. •The internal diameter (ID) in millimeters is used to define the size of the tube;
for instance an 8.0 mm tube might be used for an average adult male.
•The outer diameter (OD) is also marked.
•The distal end of the tube has a left-facing bevel to improve the view at
laryngoscopy, during which the tube is inserted from the right-hand side.
•The cuff is positioned just distal to the glottis which, in an adult, leaves the tip
of the tube a few centimeters proximal to the carina.
•There is often a mark which should remain visible just proximal to the glottis
to aid positioning.

68. •Many tubes incorporate a ‘Murphy eye’, a side hole at the tip which allows
continued ventilation if the end abuts the tracheal wall.
•Distance from the tip is marked in centimeters along the tube’s length; tubes
are often cut prior to insertion to reduce kinking under the weight of the
breathing system.
•There is a standard 15 mm connection for the breathing system at the
proximal end.
•A radio-opaque line runs the length of the tube to allow identification by X-
ray
•Uncuffedtubes were traditionally favouredin pediatrics,

69. •The cuff creates a seal in the trachea to allow higher ventilation pressures and
to prevent aspiration.
•It is connected to a pilot balloon which incorporates a valve for injecting air.
•The cuff should be inflated to the lowest pressure at which there is no longer
an air leak, which should be in the range of 20–30cmH2O.
•Modern cuffs are usually low-pressure, high-volume designs which spread
lower pressures over a larger area of trachea.
•Older cuffs were high-pressure, low-volume and risked tracheal ischaemia
and necrosis if used for long periods.

70. •Advantages
•The gold standard ‘definitive’ airway.
•Helps prevent aspiration.
•Allows some leeway in sizing of the tube .
•Allows high ventilation pressures
•Disadvantages
•Requires advanced airway skills to insert when compared with
supraglotticairway devices.
•Risk of pressure necrosis both at the level of the cuff, and in the
oropharynx if used for long periods.
•Risk of cuff herniation proximally through the glottis.

71. •Sizing endotracheal tubes
•ETT sizing is patient-specific.
•The ETT should always pass easily through the glottis, but be large
enough to prevent a leak and to minimize resistance to airflow.

73. UncuffedTube
•Uncuffedtubes are often used in pediatrics because of concerns of necrosis
caused by cuff pressure at the level of the cricoid cartilage, the narrowest
point of the pediatric airway.
•Uses
•Pediatrics (neonate to puberty).
•Adult sizes are available but are used infrequently

74. •Advantages
•Uncuffedtubes provide the widest possible lumen for a given external
diameter, thus reducing resistance.
•The risk of pressure necrosis caused by a cuff is avoided.
•The lack of cuff reduces risk of trauma at glottis during insertion (or nose
during nasal intubation).
•Disadvantages
•Must be correctly sized to prevent a leak.
•Unable to compensate for changes in airway diameter occurring during
long term ventilation.
•High ventilation pressures not achievable due to leak.

76. South RAE (Ring, Adair And Elwyn) Tube
•Anatomically shaped tubes introduced by Ring, Adair and Elwyn, designed to
position the tube and breathing circuit out of the surgical field.
•They are available cuffed or uncuffed, and the uncuffedversions have a
double Murphy eye.
•In most individuals, the tube is correctly positioned when the thick black line
is at the lower lip.

77. •Uses
•Head and neck surgery, ophthalmic surgery.
•Advantages
•Improves surgical access.
•Reduces surgical interference with the tube.
•Disadvantages
•The preformed shape may not fi t all individuals and increases the risk of
endo-bronchial intubation or cuff prolapse.

79. North RAE/Nasal Tube
•Anatomically curved shape.
•May be cuffed or uncuffed.
•To insert under direct vision, laryngoscopy is performed and the tube is
gently inserted through the nostril, directed towards the glottis.
•Final placement with Magill’s forceps is often required. Following insertion,
the right-angle curve is designed to sit at the external nares and the tube is
taped in place along the nose.

80. •Uses
•Maxillofacial or dental surgery.
•As an alternative to tracheostomy for respiratory wean.
•Advantages
•Permits unimpeded surgical access to the oral cavity.
•Better tolerated in semi-conscious or awake patients.
•The patient cannot bite the tube.
•The tube is easily stabilized.
•Disadvantages
•Risk of epistaxis.
•Contraindicated in basal skull fracture.

82. Reinforced Tube
•Reinforced tubes are made of PVC, with a spiral metal reinforcement
which allows the tube to bend without kinking.
•Often used in situations where the tube must be positioned away from
the surgical field.

83. •Uses
•Neurosurgery, maxillofacial surgery, shoulder surgery.
•Prone positioning.
•With some fibreopticor indirect laryngoscopy techniques.
•Advantages
•Bends without kinking.
•Disadvantages
•Cannot be cut to size.
•Remains deformed if bitten by the patient, causing obstruction

85. Double Lumen Endo-Bronchial Tube
•Double lumen tubes (DLTs) are specialized tubes which allow isolation of a
lung and single lung ventilation.
•Alternative, infrequently used techniques include positioning a single lumen
tube beyond the carina or using a bronchial blocker
•Uses
•DLTs are most commonly used to facilitate thoracic surgery, but may also
be used on intensive care.
•To protect the good lung from contralateral pathology
•To allow ventilation in the presence of a major air leak

87. •Insertion of a DLT
•Select an appropriate size tube (35 Fr or 37 Fr for women, 39 Fr or 41 for men).
•Ensure that you have the connection to the breathing system and that the stylet is
appropriately curved; exaggerating the bronchial curve is often helpful.
•Perform direct laryngoscopy and intubate the larynx with the bronchial curve
angled anteriorly.
•As soon as the tip passes through the cords, remove the stylet and rotate 90°
towards the desired bronchus (i.e. to the left for a left-sided DLT). Airway trauma
can result if the stylet is not removed.
•Continue advancing until resistance is felt.
•Connect the breathing system and inflate the tracheal cuff. At this point, a correctly
positioned DLT should function like a standard single lumen tube and ventilate
both lungs.

89. •Advantages
•Isolates lung from contralateral pathology.
•Permits independent suctioning of each lung.
•Permits independent ventilation of each lung.
•Allows CPAP to be applied to the non-ventilated lung.
•Disadvantages
•DLTs are bulky and may be challenging to insert.
•Prone to moving during patient positioning or surgery
•May need to change from or to a single lumen tube before or after
surgery

90. InfraglotticAirways
Tracheostomy tubes

92. Tracheostomy Tubes
•Tracheostomy tubes are curved tubes inserted through an opening
created in the patient’s neck which passes into the upper trachea.
•They are therefore infraglotticairways.
•The tracheostomy tube may initially be inserted surgically or using a
percutaneous technique.
•Most commonly, this is performed under general anaesthesia, however,
tracheostomy under local anaesthesiamay be carried out in patients in
whom there is a risk of complete airway obstruction under general
anaesthesia.

93. •Uses
Upper airway obstruction
•Tracheostomies are indicated in upper airway obstruction which cannot
be bypassed by an oral endotracheal tube.
•They may be used prior to, or following, head and neck surgery.
•They are an option in ‘can’t intubate, can’t ventilate’ situations.
Respiratory wean
•Tracheostomies are well tolerated by non-sedated patients, thus
facilitating long-term support of ventilation during respiratory wean.
•They permit suctioning of the airway in patients unable to clear
secretions.

95. •Outer tube
•This consists of a curved plastic tube with a proximal flangethat is
sutured or tied in position on the neck.
•The tube has a proximal 15mm connection for a breathing system.
•Some devices have an adjustable flange, allowing accommodation of
abnormal anatomy such as a large neck, or a distal tracheal obstruction.
•Adult tubes of ID 6.0–10.0mm are available.
•Larger sizes are preferable where possible because of the reduced
chance of mucus plugging.
•The outer tube may be cuffed or uncuffed.

96. •Inner tube
•The inner tube is a simple plastic sleeve that slides inside the outertube
and may easily be replaced if it becomes plugged with mucus.
•Paediatrictubes are often of a single lumen design (without an inner tube)
because of their narrow diameter; this necessitates more frequent tube
changes to prevent mucus plugging
•Obturator
•This is a plastic insert with a bullet-shaped tip which protrudes from the
tracheostomy tube to facilitate tube insertion.
•It must be removed in order to ventilate

97. •Speech with a tracheostomy
•In some patients, deflating the cuff or using an uncuffedtracheostomy
tube will allow enough airflow around the tube to permit speech and
coughing.
•In order to force the exhaled air through the vocal cords rather than the
tube, the tracheostomy may be covered by hand or a one-way speaking
valve such as a Passy-Muir.
•To improve speech quality, a fenestrated tracheostomy tube may be used.
•Both the outer and inner tube must be fenestrated, though the inner tube
may be changed back to a plain tube for suctioning or for short term
ventilation.

98. •Advantages
•Tracheostomies are better tolerated than oral or nasal intubation, allowing
sedation to be weaned.
•Oral hygiene is improved.
•A tracheostomy may be the only airway option in patients with upper
airway lesions.
•Dead space and airway resistance are reduced.
•Facilitation of pulmonary suctioning.
•Disadvantages
•Airway loss
•Pneumothorax
•Secretions may block the tube causing airway obstruction
•local infection.

100. UncuffedTracheostomy Tube
•Uses
•In patients who can protect their own airway and manage their secretions
by coughing.
•In pediatrics (avoidance of pressure necrosis of the trachea and to
maximize the internal diameter).
•Disadvantages
•Unless the tube is a close fi t, positive pressure ventilation will not be
possible because of the air leak around the tube.

101. “
”
Thank You
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