Intubation

Indications

• A – protection and patency (e.g. against aspiration or relief of upper airway obstruction as in anaphylaxis or head and neck trauma)
• B – respiratory failure (hypercapnic or hypoxic), increase FRC, decrease WOB, secretion management/ pulmonary toilet, to facilitate bronchoscopy
• C – minimise oxygen consumption and optimize oxygen delivery (e.g. sepsis)
• D – unresponsive to pain, terminate seizure, prevent secondary brain injury
• E — temperature control (e.g. serotonin syndrome)

Complications

• A – CICV, failed intubation, damage at intubation, mouth ulceration and bleeding
• B – VAP, VILI, barotraumas, oxygen toxicity, patient ventilator asynchrony
• C – decreased RV preload and increased RV afterload, decreased splanchnic blood flow, increased ICP, fluid retention due to decreased Q, decreased renal blood flow
• D – neuropsychiatric complications, insomnia, pain, weakness, PTSD

Securing

• Securing ETT for Neuroprotection
  • Secure the ET tube using cloth ties positioned superiorly above the ears and around the occiput
    • This avoids possible impairment to cerebral venous outflow by jugular vein compression
    • This is a rapid way to secure the airway in difficult conditions where movement may be common

Sources

• Intubation and Mechanical Ventilation • LITFL • CCC Ventilation
• Above the Ears • LITFL • Emergency Procedures