Clinical Procedure
 
Aliases:
ETT
Tracheal tube
Endotracheal intubation
Intubate

Topic aliases are alternate phrasings for a particular topic.


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Intraoperative ventilation-
Indicated for patients undergoing general anaesthesia in cases where :
1. muscle relaxation will be required,
2. high ventilation pressures are likely to be encountered (the overweight patient, laparoscopy in the trendelenberg position),
3. the patient is at high risk of gastric regurgitation
4. avoidance of hypercarbia is important (eg craniotomy)
5. the prone position will be required

Critical care-
1. disturbance in consciousness in which the patient is unable to protect their airway
2. tracheobronchial toilet
3. severe pulmonary or multisystem injury associated with respiratory failure, such as sepsis, airway obstruction, hypoxemia, and hypercarbia

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In the event of esophaegeal intubation, consider leaving this tube in place & use this as a visual guide to pass a bougie into the trachea. It also allows ventilation of gastric contents out of stomach without contaminating airway. refl.in/83

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ETT size in paediatrics (internal diameter):
Age < 2:
Newborn:
3 - 3.5 or
Gestational age/10
Newborn - 12 mo: 3.5-4
12-18 mo: 4
2 yr: 4.5
Age > 2 yr: (age/4) 4

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Ensure a pulse oximeter is placed on the patient to confirm oxygenation throughout.

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If hypoxia despite a confirmed endotracheal position and all measures to improve, consider disconnecting endotracheal tube from circuit for 30 seconds to exclude gas trapping as a cause.

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Nov 14, 2012
This occured with us following the intubation of a 3yr old child with cerebral palsy and respiratory failure thought due to aspiration pneumonia. Saturations improved from 85% to 98% after 30 seconds
The size (in french) of the ETT suction catheter is approximately twice that of the internal diameter of the ETT. Eg size 6 suction catheter for a size 3.0 ETT, size 8 suction catheter for a size 4 ETT.

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This study of 90 patients suggests that the optimal dose of fentanil required to blunt the sympathetic response to intubation depends on the presence of preexisting hypertension.
2mcg/kg fentanil 2mins prior to intubation is required in non-hypertensive patients.
4mcg/kg fentanil 2mins prior to intubation is required in patients with prexisting hypertension

dx.doi.org/10.1007/s00540...

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Assess depth of ETT by ballotting for cuff above supratentorial notch & feeling for transmitted pressure in pilot balloon. Pull back until felt, but consider risk of extubation.

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If the ETT is getting stuck on the anterior surface of the tracheal wall try rotating the ETT 180 degrees once its past the cords to reduce its angle of attack.
#AS

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When suctioning the endotracheal tube, intermittently release the suction every few centimeters on the way out to avoid stripping the airway mucosa which could lead to airway bleeding. #IM #RCH

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