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Endotracheal intubation is a standard medical procedure regularly performed in hospitals worldwide. While the process of passing a tube in a patient's airway sounds straightforward, it does come with some inherent risks.
For instance, emergency tracheal intubation can lead to major complications in critically ill patients. Hemodynamically unstable patients receiving vasopressor therapy before intubation are at a particularly high risk of mortality. Therefore, physicians performing the procedure must be skilled in airway management to minimize the risks of morbidity and iatrogenic mortality.
What can doctors and first responders do to minimize the potential for intubation-related complications?
Although physicians can perform endotracheal intubation nasally or orally, oral intubation is the preferred method in most cases. The reasons for intubating a patient can be numerous. By inserting a flexible tube in the throat, doctors can help the patient breathe, remove blockages, open up the airways to give oxygen or anesthetic and even prevent the patient from breathing in liquids.
Depending on its purpose, the procedure will vary. However, one thing that will not change is the need for the doctor performing the intubation to thoroughly understand the airway's anatomy.
The airway, or respiratory tract, includes the organs that allow airflow during ventilation. It is divided into the upper and lower airways, both of which encompass different organs performing specific functions.
The pharynx is located between the base of the skull and the esophagus. This portion of the upper airway is lined with mucous membrane and has three distinct parts:
The nasopharynx - also referred to as rhino-pharynx - is a muscular tube that includes the posterior nasal cavity. The oropharynx is the region between the palate and the hyoid bone, connecting the nasopharynx and the hypopharynx. And finally, the hypopharynx connects the oropharynx to the esophagus and the larynx, the area below the hyoid bone. The larynx divides the upper and lower airways and contains the organs that play a role in speech production. It includes the organs of the epiglottis and the vocal cords.
The lower part of the larynx connects to the trachea, which stretches to the intersection known as the carina, which branches into the left and right primary bronchi. Each of these bronchi branches into a secondary (lobar) and then tertiary (segmental) bronchi. When intubating a patient, it is essential to know that the right and left main stem bronchi are slightly different, with the right main bronchus being less angled than the left main stem bronchus. This difference means that inserting an endotracheal tube too far down into the lower airway may injure the right side.
As you can see, a thorough understanding of airway anatomy can help doctors reduce unnecessary injuries to patients during intubation.
Although airways are similar from an anatomical standpoint, multiple factors can affect the texture and shape of the organs of the respiratory tract. Age is one such factor, and doctors must keep this in mind when intubating very young or elderly patient populations. For instance, young children and infants have much smaller airways, which can complicate the procedure. Similarly, elderly patients are more prone to intubation-related injuries due to their weaker and thinner airways. Furthermore, as we age, our muscle tone decreases - including in our airways - which can lead to structural changes, making intubation riskier.
Based on the above, although mastering airway anatomy for intubation can significantly reduce the risk of complications during the procedure, doctors should consider individual patient variables.
Despite appropriate airway management training, experience, risk assessment, and clinical judgment, even skilled physicians have trouble accurately predicting which patient will present with a difficult airway. Studies suggest that more than 90% of difficult airways are unanticipated. Patient characteristics, medical and surgical history, airway examination, and the clinical context all play a role in helping a doctor assess the risk of a complex airway case.
It has been shown that patients requiring more than two intubation attempts have a significantly greater risk of complications. Therefore, it is recommended to seek out innovative technologies to facilitate the safe and effective intubation of patients with difficult airways. QuickSteer™ allows physicians to control the stylet tip direction and placement, resulting in quicker intubation of patients with challenging airways. By improving the first-pass success rate, this tiny device can help improve patient safety and workflow and decrease OR costs.
Watch this video to see QuickSteer™ in action.
Want to learn more? Connect with a specialist by calling 763.330.2162 or emailing info@accessairways.com.
