Artificial airways

Purpose:

Lift the tongue & epiglottis away from the posterior pharyngeal wall & prevent them from obstructing the space above larynx

1. Artificial Airways
Dr. Abhijit Diwate
Cardio-Vascular & Respiratory PT
DVVPF College of Physiotherapy,
Ahmednagar 414111

2. Artificial Airways
•Purpose:
Lift the tongue & epiglottis away
from the posterior pharyngeal wall &
prevent them from obstructing the
space above larynx

3. Objectives
•Oropharyngeal
•Nasopharyngeal
•Endotracheal Tubes
•Tracheostomy tubes

4. Oropharyngeal Airway
Indications
–Maintain airway in the unconscious
patient
–Protects an Endotracheal Tube from
being bitten
–Facilitates Airway Suctioning

5. Guedal Airway

6. Berman Airway
•It has a center support &
open sides
•Has a flange at the buccal
end

7. Ovassapian Airway
•The Ovassapian airway is used to facilitate
fiber-optic intubation.
•Overall shape is similar to a Geudal airway,
but is open on the top
•A tubular shaped guide in the center
facilitates passage of fiber-optic
laryngoscope.

8. Williams Intubating Airway
•This is designed to facilitate
fiber-optic intubation.
•It is similar in profile to the
guedal airway, it is open on
the distal half, and cylindical
at the proximal portion.
•It is only available in 2 sizes
9 cm and 10 cm.

9. Cuffed Oro-phayrngeal Airway
(COPA)
•A Guedal airway with an
inflatable cuff to seal the
oropharynx
•A 15 mm connector to attach
to breathing circuit
•Cuff inflated with 25 to 40 cc
air

10. LT Oro pharyngeal Airway
•This has a 15 mm adaptor for
connection to the anesthesia
circuit.
•Come in different sizes and are
color coded.
•They are not available in
pediatric sizes.

11. Nasopharyngeal Airway
Indications
–Airway maintenance
•Oral Airway placement difficult
–Nasotracheal intubation
guide in maxillofacial trauma
Complications
–Esophageal intubation (if too
long)
–Laryngospasm
–Vomiting
–Nasal mucosa injury and
secondary blood aspiration

12. ENDOTRACHEAL
TUBES

13. Determining Sizes
Internal Diameter (ID)
•Newborns
<28 wks (<1000 g): 2.5 mm
28-34 wks (1000-2000 grams): 3.0 mm
34-38 wks (2000-3000 grams): 3.5 mm
>38 wks (>3000 grams): 3.5 to 4.0 mm

14. Intermediate Tracheal Tube
•Excellent for oral and nasal
intubations where a shorter
cuff is desired
• Features:
–Murphy tip and eye
–Tip-To-Tip radiopaque
line
–Pilot balloon and
mechanical self-sealing
valve

15. Tracheal Tube
•Meets the guidelines of
the cuff criteria.
•Thin cuff conforms to
uneven tracheal
surfaces to create low
pressure seal.
•Large cuff diameter of 1-
1/2 times the average
trachea maintains proper
low-pressure seal

16. COLE TRACHEAL TUBE
•Patient end smaller than rest of
tube
•Sized according to the ID of the
tracheal portion
•Widened portion should not contact
larynx
•Cannot be used nasally as the wide
segment will not pass through nares

17. Evac Endotracheal Tube with
Evacuation Lumen
Convenient and safe
method for suctioning
accumulated secretions
in the subglottic space
Low VAP incidence
Useful for gas sampling,
airway pressure
monitoring, giving drugs
& jet ventilation

18. Jet Tracheal Tube
•Features:
–Magill curve
–Uncuffed
•Includes:
–Main Lumen for
ventilation
–Insufflation lumen
permits the delivery of
jet ventilation

19. Endobronchial double lumen tube

20. With CPAP System
•Improves oxygenation
during one-lung anesthesia.
•Anesthesia bag to aid
opening alveoli.
•Adjustable valve supplies
pressures in clinical
settings from 1 to 10cm
H20.

21. Oral Ring Adair Elwin tracheal Tube
•Preformed curve removes
circuit from surgical field.
•Unique design assures
patent airway while reducing
risk of kinks and
disconnects.
•Rectangular mark at
preformed curve aids
correct positioning.

22. Nasal RAE Tracheal Tube

23. Indications
•Nasal surgery & Facial surgery
•Ophthalmic surgery
•Prone positioning

24. Laser – Flex Tracheal Tube
•Stainless steel body is
airtight, flexible and laser-
resistant.
•Reflected beams from the
tube are defocused to
reduce accidental laser
strikes to healthy tissue.
•Smooth surface and Magill
curve minimize trauma
during intubation.

25. Combitube

26. Features
•For difficult or emergency intubation.
•Blind placement without laryngoscope.
•Unique design provides patent airway with
either esophogeal or tracheal placement.
•Reduces risk of aspiration of gastric
contents.

27. Lo-Contour Tracheal Tube
•Cuff lies close to the tube
while deflated for better
view of vocal cords
•Translucent white tube is
easy to see in trachea
•Adequate cuff diameter
provides low-pressure
seal.

28. ET Tube with Controllable Tip
•Loop controls the
direction of the tip
•Radius of curvature is
reduced by pulling the
loop
•Useful in blind intubations

29. Reinforced Tracheal Tube
•Soft, flexible PVC tube
with spiral-wound
reinforcing wire
•Reduced risk of kinking.
•Reinforcing wire is
sealed tightly against
bonded connector.

30. Tube with Lanz Pressure Regulating
Valve
•Reduces risk of
tracheal damage
during long-term
intubations.
•Lanz valve reduces
the need for manual
cuff pressure
monitoring.

31. Microlaryngeal Tracheal Tube
•Small cuff size & I.D. and O.D.
provide greater access
•ID of 4, 5 or 6 mm only
•Cuff diameter: that of 8 mm
tube
•Used when airway has been
narrowed by a tumor or other
abnormality.

32. Preformed Laryngectomy
Tube

33. Uncuffed Tracheal Tube
•Wide range of pediatric
sizes
•Provides better fit even for
premature infants.
•Distal tip reference lines
and depth marks
•Thin, but strong tube wall
provides maximum inner
diameter for proper
ventilation.

34. Uncuffed Tracheal Tube with
Monitoring Lumen

35. Tracheostomy
Tubes

37. J Shaped Tracheostomy Tubes
•Available in larger sizes for
patients with a tracheostomy.

•The short portion of the J is
inserted into the trachea, and
the long portion lies flat
against the chest
•Reduces risk of accidental
disconnection/extubation

38. Summary
•Oropharyngeal airways
•Nasopharyngeal airways
•Endotracheal Tubes
•Tracheostomy tubes

39. QUESTIONS
1.WRITE ABOUT THE J SHAPED
TRACHEOSTOMY TUBES. 3MARKS
2.WRITE ABOUT ENDOTHECAL
TUBES. 7MARKS

40. Thank you