Endotracheal intubation & its complications

With technical advances & improved survival of criticlly ill patients delayed outcome of endotracheal intubation are getting evident.

1. Endotracheal Intubation & It’s Complications Dr Shrikant Phatak Head of ENT Department Choithram Hospital & Research Center Indore

2. Endotracheal Intubation &It’s Complications Endotracheal intubation is done for general anaesthesia, assisted ventilation ,to secure the air way & for cardio pulmonary resuscitation. With the improved critical care &survival complications of intubation are getting evident. The complications can be prevented by proper care of the tube, selecting proper size of the tube & ensuring proper position of the tube in the air way.

3. Air Way An ENT Perspective Adult larynx is cylindrical so the narrowest part of the upper airway is the Glottis. In children it is funnel shaped the narrowest part is at the cricoid cartilage. These are the vulnerable areas in a forceful intubation. Laryngeal edema occurs much more rapidly in pediatric age group

4. Standard protocol For tube size & depth The exact size of the endotracheal tube to be put should be tailored according to the individual patient . The inter arytenoid distance is the deciding factor. As the tube rests in posterior glottis the chances of trauma are maximum in the Inter arytenoid area

5. Endotracheal Intubation & It’s Complications The complications can be 1 Immediate 2 Delayed Here we are discussing the delayed complications of prolonged intubation. If proper care is not taken even patients are seen to have stridor &respiratory distress even after a short intubation for 36 hours

6. Endotracheal Intubation &It’s Complications If ventilatory support is needed for more than 5 to7 days Tracheostomy is required. Proper sedation level post intubation prevents tracheal wall injury by the tube. Any voice change or breathing difficulty post extubation needs upper airway assessment by ENT surgeon & X-Ray Soft tissue neck lateral view.

7. Endotracheal Intubation &It’s Complications Lie of the tube in the tracheal lumen Tube in Right bronchus

8. Position of the Tube & Cuff A high placed tube with the inflated cuff in glottis or immediately below the cords in sub glottis this can cause in Supraglottic & Glottic damage .

9. Lye Of the Tube in the lumen of the Trachea The lie of the tube in the lumen of The Trachea is influenced by the position of the connecting tubing in the circuit. Faulty position of the connections in the circuit can change the tilt of tube in the tracheal lumen & cause trauma by the Beveled tip which in the long term causes stenosis

10. Endotracheal Intubation & It’s Complications Position of the tube if tube is not parallel in the lumen Tube tip can cause mucosal Trauma A curved Tracheostomy tube tip can cause mucosal trauma

11. Sequel of prolong Intubation

12. Endotracheal Intubation & It’s Complications Normal Inter arytenoid Distance decides the tube size Inter arytenoid Distance in adult with infantile Epiglottis will accommodate smaller tube

13. Endotracheal Intubation & It’s Complications Inter arytenoid area ET Tube Pressure Point Trauma to the arytenoids heals by fibrosis leads to Stenosis

14. Endotracheal Intubation &It’s Complications Ulceration Angle of Mouth Position Tube In Right Bronchus

15. Endotracheal Intubation & It’s Complications Intubation Granuloma

16. Endotracheal Intubation & It’s Complications Cord Injury Posterior Supraglottic Web

17. Endotracheal Intubation &It’s Complications Supraglottic Stenosis X-Ray Subglottic Web

18. Endotracheal Intubation &It’s Complications Subglottic Stenosis Tracheal Narrowing

19. Endotracheal Intubation & It’s Complications Supra stomal Stenosis Supra stomal Stenosis

20. Endotracheal Intubation & It’s Complications Grade 4 Subglottic Stenosis Subglottic Granulation & Web

21. Disclaimer The information contained in the presentation is based on the personal experience and cases collected at Choithram Hospital Indore over the last 20 years. It is intended for the use of Medical students ENT& anesthesia post graduates & intensivists. The views expressed are purely on personal opinion. viewers can make their own opinion. For any confusion please contact sole author. Everybody is allowed to copy or download the material best suited to him. I am not responsible for any controversies arising out of the presentation. For any suggestions or corrections you may please contact [email protected]

22. Endotracheal Intubation & It’s Complications Thank you