4Infraglottic airway devices and techniques
Section snippets
Endotracheal intubation
Endotracheal intubation is the most common technique for securing the airway. It provides best protection against aspiration of foreign material1 and is commonly used in anaesthesia, emergency medicine and intensive care.
The introduction of a cuff-sealed endotracheal tube through the mouth or nose into the trachea offers significant advantages over other techniques, especially for the treatment of patients in critical condition (Table 1).
The cuffed endotracheal tube effectively seals the
EasyTube
The EasyTube (EzT) was developed for in-hospital and pre-hospital use in all patients with anticipated or unanticipated airway difficulties. It is a disposable device that combines the essential features of an endotracheal tube with those of a supraglottic airway.31
It consists of two lumens that allow ventilation with the tip of the tube in either the tracheal or the oesophageal position. A large oropharyngeal cuff ensures an airtight seal to the oro- and nasopharynx. The tip of the tube
Oesophageal tracheal combitube
The oesophageal–tracheal Combitube (ETC) was developed primarily as an emergency tube for ventilating patients during resuscitation.32, 33 It has two lumens, one of which resembles a conventional endotracheal tube while the other seals off the oesophagus with an oropharyngeal balloon (Figure 10).
The device is designed to ventilate the lungs depending on the positioning of the distal end (either oesophagus or trachea). The tip can be inserted into the trachea, although it has a diameter of 41
Summary
Infraglottic airway management techniques, such as intubation of the trachea with a cuff-sealed endotracheal tube, offer significant advantages for the anaesthetized patient, especially for patients in critical condition.
There are numerous ways of intubation of the trachea; the most common and popular is direct laryngoscopy. The variety of laryngoscope blades offers choices to solve difficult intubations, but all different techniques and devices need experience in routine clinical use.
In case
References (43)
- et al.
Guidelines for the advanced management of the airway and ventilation during resuscitation
Resuscitation
(1996) - et al.
Head-elevated laryngoscopy position: improving laryngeal exposure during laryngoscopy by increasing head elevation
Annals of Emergency Medicine
(2003) - et al.
Head and neck elevation beyond the sniffing position improves laryngeal view in cases of difficult direct laryngoscopy
Journal of Clinical Anesthesia
(2002) - et al.
A new universal laryngoscope blade: a preliminary comparison with Macintosh laryngoscope blades
Resuscitation
(2003) Use of the endotracheal bougie introducer for difficult intubations
American Journal of Emergency Medicine
(2004)- et al.
Retrograde endotracheal intubation: an investigation of indications, complications, and patient outcomes
American Journal of Emergency Medicine
(2005) - et al.
A new device for emergency airway management: the easy tube
Resuscitation
(2004) - et al.
The esophageal tracheal Combitube: preliminary results with a new airway for CPR
Annals of Emergency Medicine
(1987) - et al.
Use of the esophageal tracheal Combitube by basic emergency medical technicians
Resuscitation
(2002) - et al.
Current status of the Combitube: a review of the literature
Journal of Clinical Anesthesia
(2002)
Piriform sinus perforation during esophageal–tracheal Combitube placement
Journal of Emergency Medicine
A case report of difficult ventilation with the Combitube—valve-like upper airway obstruction confirmed by fibreoptic visualisation
Resuscitation
Checking correct tube placement in emergency medicine
Notfall Rettungsmed
Study of the ‘sniffing position’ by magnetic resonance imaging
Anesthesiology
Randomized study comparing the ‘sniffing position’ with simple head extension for laryngoscopic view in elective surgery patients
Anesthesiology
The levering laryngoscope
Anaesthesia
The McCoy levering laryngoscope in patients with limited neck extension
Canadian Journal of Anaesthesia
Experience with the McCoy laryngoscope in difficult laryngoscopy
Anaesthesia
Comparison of the flexiblade levering laryngoscope with the English Macintosh laryngoscope in patients with a poor laryngoscopic view
Anaesthesia
The use of paraglossal straight blade laryngoscopy in difficult tracheal intubation
Anaesthesia
Inadvertent esophageal intubation in the field: reliance on a fool's ‘gold standard’
Academic Emergency Medicine
Cited by (16)
Analysis of Out-of-Hospital Pediatric Intubation by an Australian Helicopter Emergency Medical Service
2017, Annals of Emergency MedicineCitation Excerpt :Bougie: Pediatric bougies are routinely recommended to maximize first-look success by ensuring endotracheal placement of a bougie under direct vision before passage of endotracheal tube. Use of a bougie for intubation is thought to facilitate difficult intubation and is becoming standard practice in many physician-helicopter EMS and increasingly coming into emergency medicine practice.41,42 In our cohort, 80% of intubations were performed with bougie or stylet, in contrast to less than 30% in the study by Prekker et al.29
Difficult fiber-optic intubation in a patient with giant neck masses: The role of McCoy laryngoscope in elevating compressed laryngeal aperture
2013, Acta Anaesthesiologica TaiwanicaCitation Excerpt :We expected that fiber-optic intubation would not become easier whether the patient was kept awake or sedated under intravenous anesthetics. Awake fiber-optic intubation with a flexible fiberscope is the gold standard for an anticipated difficult intubation, especially when complicated with a compromised airway.10–12 In our patient, an alternative method using a levering laryngoscope was chosen instead of a flexible fiberscope, because the bronchoscope tip was blocked by the drooping tongue and distorted laryngeal anatomy.
Esophageal-Tracheal Double-Lumen Airways: The Combitube and EasyTube
2013, Benumof and Hagberg's Airway ManagementEsophageal-Tracheal Double-Lumen Airways: The Combitube and EasyTube
2012, Benumof and Hagberg's Airway Management: Third EditionLung separation and the difficult airway
2009, British Journal of AnaesthesiaCitation Excerpt :These devices are proving useful in difficult intubation situations.105 Protocols are changing and videoscopes are replacing bronchoscopy as the first choice for accessing the difficult airway both for TTs and for DLTs.81 95 128 130 DLT placement in patients with anticipated or proven difficult direct laryngoscopy has been reported with the Bullard® laryngoscope (Gyrus ACMI, Inc., Norwalk, OH, USA),111 the WuScope® (ACHI Corp, San Jose, CA, USA),119 the GlideScope,39 64 the Pentax Airway laryngoscope,94 123 the Airtraq,66 and the Bonfils® intubation fiberscope (Karl Storz GmbH, Tuttlingen, Germany).14
The Combitube: Esophageal-Tracheal Double-Lumen Airway
2007, Benumof's Airway Management
☆The author's institution received research grants from Ruesch/Teleflex Medical, Germany, and Karl Storz, Germany.