ADVANCED AIRWAY TECHNIQUES

Advanced airway techniques are used when basic airway maneuvers are insufficient to maintain a patent airway or when prolonged ventilatory support is required. These techniques require specialized training and equipment and are typically performed by advanced healthcare providers, such as paramedics, respiratory therapists, and physicians.

ENDOTRACHEAL INTUBATION (ET)

Endotracheal intubation (ET) involves inserting a tube through the trachea into the trachea. It provides a secure and definitive airway, allowing for mechanical ventilation and protecting the airway from aspiration.

Key Components of ET Intubation:

• Laryngoscopy: Using a laryngoscope to visualize the vocal cords.
• Endotracheal Tube Insertion: Passing the ET tube through the vocal cords into the trachea.
• Confirmation of Placement: Crucial to ensure the tube is in the trachea and not the esophagus.

Advantages of ET Intubation:

• Provides a secure airway.
• Protects against aspiration.
• Allows for mechanical ventilation.
• Facilitates suctioning of secretions.

Disadvantages of ET Intubation:

• Requires specialized training and skill.
• Potential for complications (e.g., esophageal intubation, right mainstem bronchus intubation, trauma to the airway).

LARYNGEAL MASK AIRWAY (LMA)

The laryngeal mask airway (LMA) is a supraglottic airway device that is inserted into the oropharynx. It sits above the larynx, creating a seal around the glottis.

Advantages of LMA:

• Relatively easier to insert than an ET tube.
• Can be inserted by providers with less experience in airway management.
• Useful in situations where ET intubation is difficult or impossible.

Disadvantages of LMA:

• Does not provide the same level of airway protection as an ET tube (higher risk of aspiration).
• Not suitable for patients requiring high airway pressures.

CONFIRMING ADVANCED AIRWAY PLACEMENT

Confirmation of proper placement is crucial for both ET tubes and LMAs. Methods for confirming placement include:

• Direct Visualization (for ET Intubation): Observing the tube passing through the vocal cords.
• Auscultation: Listening for breath sounds over both lungs and the stomach.
• Capnography: Monitoring the level of carbon dioxide in exhaled breath. This is the most reliable method.
• Esophageal Detector Device: A device used to detect placement in the esophagus.
• Chest X-Ray: A chest x-ray can be used to confirm the position of the ET tube.

VENTILATION TECHNIQUES WITH ADVANCED AIRWAYS

Once an advanced airway is in place, ventilations are typically provided using a bag-valve-mask (BVM) connected to supplemental oxygen or a mechanical ventilator. The recommended ventilation rate is 10 breaths per minute (one breath every 6 seconds).

This lesson provides an overview of advanced airway techniques. The following lessons will provide more specific details on ET intubation and LMA insertion.