endotracheal intubation

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Indications

Contraindications

Procedure

Equipment:

Endotracheal tube:

  • average size:
    • adult male: 9 mm diameter
    • adult female: 8 mm diameter
    • neonate 3.5 mm diameter
  • preparation
    • check cuff for leaks by inflating cuff under water
    • lubricate tube & stylette
    • indert stylette into tube & bend into appropriate curve
    • do not allow stylette to protrude from tube

Give atropine:

Technique:

* reserve for difficult intubuations[8]

Confirm tube position:

Secure position of endotracheal tube

Complications

Notes

More general terms

Additional terms

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 56
  2. Bozeman WP et al, A comparison of rapid-sequence intubation and etomidate-only intubation in the prehospital air medical setting. Prehosp Emerg Care 2006; 10:8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16418085
  3. 3.0 3.1 Tripathi M and Prandy M Short thyromental distance: A predictor of difficult intubation or an indicator for small blade selection. Anesthesiology 2006; 104:1131 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16732082
  4. 4.0 4.1 Medical Knowledge Self Assessment Program (MKSAP) 16, American College of Physicians, Philadelphia 2012
  5. 5.0 5.1 De Jong A et al. Early identification of patients at risk for difficult intubation in the intensive care unit. Am J Respir Crit Care Med 2013 Apr 15; 187:832 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23348979
  6. 6.0 6.1 Badiger S et al. Optimizing oxygenation and intubation conditions during awake fibre-optic intubation using a high-flow nasal oxygen-delivery system. Br J Anaesth 2015 Aug 7 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26253608
  7. 7.0 7.1 Upchurch CP et al. Comparison of etomidate and ketamine for induction during rapid sequence intubation of adult trauma patients. Ann Emerg Med 2017 Jan; 69:24 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27993308
  8. 8.0 8.1 8.2 Lascarrou JB, Boisrame-Helms J, Bailly A et al. Video laryngoscopy vs direct laryngoscopy on successful first-pass orotracheal intubation among ICU patients: A randomized clinical trial. JAMA 2017 Feb 7; 317:483. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28118659
    O'Gara B, Brown S, Talmor D Video laryngoscopy in the intensive care unit: Seeing is believing, but that does not mean it's true. JAMA 2017 Feb 7; 317:479. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28118656
  9. 9.0 9.1 Driver BE, Prekker ME, Klein LR et al Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation. A Randomized Clinical Trial. JAMA. Published online May 16, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29800096 https://jamanetwork.com/journals/jama/fullarticle/2681717
  10. 10.0 10.1 Driver BE, Semler MW, Self WH et al. Effect of use of a bougie vs endotracheal tube with stylet on successful intubation on the first attempt among critically ill patients undergoing tracheal intubation: A randomized clinical trial. JAMA 2021 Dec 28; 326:2488 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34879143 PMCID: PMC8655668 (available on 2022-06-08) https://jamanetwork.com/journals/jama/fullarticle/2787158
  11. 11.0 11.1 Grillot N, Lebuffe G, Huet O et al Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration. A Randomized Clinical Trial. JAMA. 2023;329(1):28-38. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36594947 https://jamanetwork.com/journals/jama/fullarticle/2800025
  12. 12.0 12.1 12.2 Prekker ME et al. Video versus direct laryngoscopy for tracheal intubation of critically ill adults. N Engl J Med 2023 Jun 16; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37326325 https://www.nejm.org/doi/10.1056/NEJMoa2301601