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Intubation and ventilation

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Amir M. Safa
Amir M. Safa

This document discusses the history and indications/complications of tracheal intubation and ventilation. It outlines that intubation was first described in the late 18th century and developed through the 19th-20th centuries. The main indications for intubation are anesthesia, CPR, and respiratory failure. Complications can occur during and after intubation, including trauma, infection, and nerve damage. Ventilation is indicated for respiratory failure, anesthesia, and surgery. Complications of ventilation include cardiovascular, respiratory, and renal issues as well as risks from intubation such as barotrauma.

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TRACHEAL INTUBATION AND VENTILATION: THE INDICATIONS AND COMPLICATIONS DR A SAFA 2002
A BRIEF HISTORY OF INTUBATION • 1788 KITE DESCRIBED ORAL/NASAL INTUBATION FOR RESUSCITATION AND LARYNGEAL OBSTRUCTION • 1880 MACEWEN ADVOCATED INTUBATION RATHER THAN TRACHEOSTOMY IN HEAD+NECK SURGERY • 1885 O’DWYER DESCRIBED INTUBATING TUBE • 1895-1915 KIRSTEIN, KILLIAN, JACKSON LARYNGOSCOPY PIONEERED • POST WWI MAGILL+ ROWBOTHAM DEVELOPED MODERN ENDOTRACHEAL ANAESTHESIA AND BLIND NASAL INTUBATION
A BRIEF HISTORY OF VENTILATION • 1543 VESALIUS IN A PIG VIA TRACHEOSTOMY • 1667 HOOKE USING BELLOWS VIA TRACHEOTOMY IN A DOG • INITIALLY USED FOR CPR • 1820’S WATERTON ANIMALS+ CURARE • LATE1800’S/EARLY1900’S USED IN ANAESTHESIA • 1940’S NEUROMUSCULAR BLOCKERS INTRODUCED AND USE MORE WIDESPREAD • 1952 DANISH POLIO EPIDEMIC SAW USE INCREASED DUE TO RESPIRATORY FAILURE
TRACHEL INTUBATION INDICATIONS • ANAESTHETIC – RESTRICTED ACCESS – PROTECTION OF TRACHEA FROM SOILING – TO SECURE AIRWAY – WHEN MUSCLE RELAXATION REQUIRED – IF IPPV REQUIRED • NON-ANAESTHETIC – CPR – IF IPPV REQUIRED – TO SECURE/PROTECT AIRWAY – ALLOW ASPIRATION OF SPUTUM/SECRETIONS
TRACHEAL INTUBATION COMPLICATIONS 1 • DURING INTUBATION – TRAUMA • EYES, NECK, JAW, TEETH, LIPS, NASAL MUCOSA, MOUTH,TONGUE, PHARYNX, LARYNX, LARYNGEAL NERVES, TRACHEA • RESULTING IN – INFECTION – BLEEDING – SURGICAL EMPHYSEMA – HYPERTENSIVE RESPONSE • MAY RAISE ICP • LARYNGOSCOPY ALONE WILL CAUSE THIS – ARRHYTHMIAS – LARYNGOSPASM – BRONCHOSPASM
TRACHEAL INTUBATION COMPLICATIONS 2 – BREATH HOLDING – ASPIRATION OF GASTRIC CONTENTS – MISPLACED TUBE – FAILED INTUBATION – BACTERAEMIA
TRACHEAL INTUBATION COMPLICATIONS 3 • AFTER INTUBATION – DISPLACEMENT OF TUBE • EXTUBATION • ENDOBRONCHIAL INTUBATION – DISCONNECTION FROM FRESH GAS SUPPLY – AIRWAY OBSTRUCTION – CUFF – LASER IGNITING TUBE – COMPLICATIONS OF EXTUBATION
TRACHEAL INTUBATION COMPLICATIONS 4 • LATE COMPLICATIONS – CORD ULCERATION AND GRANULOMA – SUPERIOR/ RECURRENT LARYNGEAL NERVE DAMAGE – TRACHEAL STENOSIS – NASAL/ORAL ULCERATION – SINUSITIS
VENTILATION 1 • INDICATIONS – ICU • HEAD INJURY • RESP. FAILURE • OTHERS – COMA, POST CPR – ANAESTHETIC • NEUROMUSCULAR BLOCKADE REQUIRED • THORACIC SURGERY • INADEQUATE VENTILATION • TO CONTROL PaCO2 • TO REDUCE INHALATIONAL AGENT REQUIREMENTS • TO ENSURE ADEQUATE AIR ENTRY
VENTILATION 2 • COMPLICATIONS – CARDIOVASCULAR • REDUCED VENOUS RETURN • REDUCED CARDIAC OUTPUT • REDUCED BP (ESP AUTONOMIC NEUROP. OR HYPOVOL.) – INCREASED PULMONARY VASCULAR RESISTANCE – REDUCED LV COMPLIANCE AND FILLING (ESP IF PEEP) – RAISED MEASURED CVP – REDUCED VENOUS DRAINAGE FROM HEAD AND NECK – INCREASE ICP
VENTILATION 3 – RESPIRATORY • INTRAPLEURAL PRESSURE CHANGE • FALL IN LUNG COMPLIANCEAND FRC • ATALECTASIS LEADING TO INCREASED ALVEOLAR-ARTERIAL O2 DIFF AND DEAD SPACE – RENAL – ILEUS – RISKS OF TRACHEAL INTUBATION – BAROTRAUMA – UNDETECTED DISCONNECTION

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Intubation and ventilation

  • 1. TRACHEAL INTUBATION AND VENTILATION: THE INDICATIONS AND COMPLICATIONS DR A SAFA 2002
  • 2. A BRIEF HISTORY OF INTUBATION • 1788 KITE DESCRIBED ORAL/NASAL INTUBATION FOR RESUSCITATION AND LARYNGEAL OBSTRUCTION • 1880 MACEWEN ADVOCATED INTUBATION RATHER THAN TRACHEOSTOMY IN HEAD+NECK SURGERY • 1885 O’DWYER DESCRIBED INTUBATING TUBE • 1895-1915 KIRSTEIN, KILLIAN, JACKSON LARYNGOSCOPY PIONEERED • POST WWI MAGILL+ ROWBOTHAM DEVELOPED MODERN ENDOTRACHEAL ANAESTHESIA AND BLIND NASAL INTUBATION
  • 3. A BRIEF HISTORY OF VENTILATION • 1543 VESALIUS IN A PIG VIA TRACHEOSTOMY • 1667 HOOKE USING BELLOWS VIA TRACHEOTOMY IN A DOG • INITIALLY USED FOR CPR • 1820’S WATERTON ANIMALS+ CURARE • LATE1800’S/EARLY1900’S USED IN ANAESTHESIA • 1940’S NEUROMUSCULAR BLOCKERS INTRODUCED AND USE MORE WIDESPREAD • 1952 DANISH POLIO EPIDEMIC SAW USE INCREASED DUE TO RESPIRATORY FAILURE
  • 4. TRACHEL INTUBATION INDICATIONS • ANAESTHETIC – RESTRICTED ACCESS – PROTECTION OF TRACHEA FROM SOILING – TO SECURE AIRWAY – WHEN MUSCLE RELAXATION REQUIRED – IF IPPV REQUIRED • NON-ANAESTHETIC – CPR – IF IPPV REQUIRED – TO SECURE/PROTECT AIRWAY – ALLOW ASPIRATION OF SPUTUM/SECRETIONS
  • 5. TRACHEAL INTUBATION COMPLICATIONS 1 • DURING INTUBATION – TRAUMA • EYES, NECK, JAW, TEETH, LIPS, NASAL MUCOSA, MOUTH,TONGUE, PHARYNX, LARYNX, LARYNGEAL NERVES, TRACHEA • RESULTING IN – INFECTION – BLEEDING – SURGICAL EMPHYSEMA – HYPERTENSIVE RESPONSE • MAY RAISE ICP • LARYNGOSCOPY ALONE WILL CAUSE THIS – ARRHYTHMIAS – LARYNGOSPASM – BRONCHOSPASM
  • 6. TRACHEAL INTUBATION COMPLICATIONS 2 – BREATH HOLDING – ASPIRATION OF GASTRIC CONTENTS – MISPLACED TUBE – FAILED INTUBATION – BACTERAEMIA
  • 7. TRACHEAL INTUBATION COMPLICATIONS 3 • AFTER INTUBATION – DISPLACEMENT OF TUBE • EXTUBATION • ENDOBRONCHIAL INTUBATION – DISCONNECTION FROM FRESH GAS SUPPLY – AIRWAY OBSTRUCTION – CUFF – LASER IGNITING TUBE – COMPLICATIONS OF EXTUBATION
  • 8. TRACHEAL INTUBATION COMPLICATIONS 4 • LATE COMPLICATIONS – CORD ULCERATION AND GRANULOMA – SUPERIOR/ RECURRENT LARYNGEAL NERVE DAMAGE – TRACHEAL STENOSIS – NASAL/ORAL ULCERATION – SINUSITIS
  • 9. VENTILATION 1 • INDICATIONS – ICU • HEAD INJURY • RESP. FAILURE • OTHERS – COMA, POST CPR – ANAESTHETIC • NEUROMUSCULAR BLOCKADE REQUIRED • THORACIC SURGERY • INADEQUATE VENTILATION • TO CONTROL PaCO2 • TO REDUCE INHALATIONAL AGENT REQUIREMENTS • TO ENSURE ADEQUATE AIR ENTRY
  • 10. VENTILATION 2 • COMPLICATIONS – CARDIOVASCULAR • REDUCED VENOUS RETURN • REDUCED CARDIAC OUTPUT • REDUCED BP (ESP AUTONOMIC NEUROP. OR HYPOVOL.) – INCREASED PULMONARY VASCULAR RESISTANCE – REDUCED LV COMPLIANCE AND FILLING (ESP IF PEEP) – RAISED MEASURED CVP – REDUCED VENOUS DRAINAGE FROM HEAD AND NECK – INCREASE ICP
  • 11. VENTILATION 3 – RESPIRATORY • INTRAPLEURAL PRESSURE CHANGE • FALL IN LUNG COMPLIANCEAND FRC • ATALECTASIS LEADING TO INCREASED ALVEOLAR-ARTERIAL O2 DIFF AND DEAD SPACE – RENAL – ILEUS – RISKS OF TRACHEAL INTUBATION – BAROTRAUMA – UNDETECTED DISCONNECTION