What Are the Different Indications for Intubation?

Tracheal intubation is a method of placing a special endotracheal tube through the mouth or nasal cavity through the glottis into the trachea or bronchus. It provides the best conditions for airway patency, ventilation, oxygen supply, and airway suction. Important measures.

Basic Information

Chinese name: Tracheal intubation
Anesthesia: Local anesthesia

Indication: Sudden stop of spontaneous breathing, etc.
Contraindications: Laryngeal edema, acute airway inflammation, etc.

Tracheal intubation anesthesia

Local anesthesia.

Preoperative preparation for tracheal intubation

1. Routinely perform inspections such as nasal cavity, teeth, mouth opening, neck mobility, throat, etc., remove mouth, nose, and pharyngeal secretions and remove dentures.
2. When necessary, consider appropriate administration of sedatives and muscle relaxants.
3. Intubation in patients with obstructive sleep apnea-hypopnea syndrome is relatively safe.

Indications for tracheal intubation

1. Sudden stop of spontaneous breathing.
2. Those who cannot meet the ventilation and oxygen supply needs of the body and need mechanical ventilation.
3. Can not clear the upper respiratory tract secretions, gastric contents reflux or bleeding at any time.
4. The presence of upper respiratory tract injury, stenosis, obstruction, etc. that affects normal ventilation.
5. Central or peripheral respiratory failure.

Contraindications for tracheal intubation

1. Laryngeal edema, acute airway inflammation, laryngeal submucosal hematoma, severe bleeding caused by tracheal intubation; endotracheal intubation is contraindicated except for emergency treatment.
2. Throat burns, tumors or foreign bodies.
3. Aortic aneurysms compress the trachea. Intubation easily causes aneurysm injury and bleeding is a relative contraindication.
4. It is difficult for the lower respiratory tract secretion to be removed from the intubation. Tracheotomy and intubation should be performed.
5. Others, such as cervical fractures and dislocations.
6 Patients with incomplete airway obstruction have indications for intubation, but rapid induction of intubation is contraindicated.
7. Hemorrhagic blood diseases (such as hemophilia, thrombocytopenic purpura, etc.). Intubation injury is likely to induce glottic or tracheal submucosal hemorrhage or hematoma, and secondary acute obstruction of the respiratory tract is a relative contraindication.

Tracheal intubation procedure

1. Supine position, pillow under the shoulder, head tilted back, so that the mouth, throat and trachea are in the same longitudinal axis direction.
2. Hold the laryngoscope with your left hand and slowly insert it along the back of the tongue, and gently lift the epiglottis cartilage to the base of the tongue to reveal the glottis. After the inspiratory glottal valve is opened, the right-handed tracheal tube is quickly inserted into the trachea. Withdraw the die, place a dental pad, and exit the laryngoscope.
3. Check whether gas is discharged from the outside of the tracheal tube with the breath, or whether the breathing sounds of the lungs on both sides of the auscultation are consistent. After confirming that the intubation is correct, fix it with the dental pad. The depth of the catheter into the trachea is 4-5 cm for adults, and the distance from the tip of the catheter to the incisors is 18-22 cm.
4. Inject 5 ml of air into the balloon at the front of the catheter to close the gap between the catheter and the trachea wall.

Complications of tracheal intubation

1. Excessive force or rough movement during intubation can cause teeth to fall off, or damage the nasal cavity or throat mucosa, causing bleeding. Can also cause dislocation of the jaw joint.
2. The catheter is too thin and the inside diameter is too small, which can increase the resistance of the airway. Even the catheter is blocked due to compression and tortuosity. The catheter is too thick and stiff, which can easily cause edema of the throat and even cause granuloma of the throat.
3. Catheter inserted too deep into the bronchi can cause hypoxia and atelectasis on one side. When the catheter is inserted too shallowly, it can be accidentally pulled out due to changes in the patient's position. Note the change in the position of the catheter during the operation.

Notes on tracheal intubation

1. The intubation operation must be gentle, choose the size of the catheter so that it can easily pass through the glottic fissure, too thick or violent insertion can cause throat and tracheal damage, and too detailed rules are not conducive to breathing.
2. After the catheter tip passes through the glottis, go deeper 5 ~ 6cm, so that the cuff completely crosses the glottis. Do not accidentally enter the bronchus or esophagus on one side.
3. Cuff inflation is to close the gap between the catheter and the tracheal wall. Do not inject blindly a large amount of air and cause ischemic necrosis of the tracheal wall.
4. After the surgical position is placed, the endotracheal suction should be tested and the catheter is unobstructed.

Nursing after tracheal intubation

1. Keep the tracheal tube open and aspirate secretions in time.
2. Keep the mouth clean. Leave the trachea intubated for more than 12 hours, and perform oral care twice a day.
3. Strengthen airway temperature management and humidification management.
4. Tracheal intubation is generally retained for no more than 3 to 5 days. If further treatment is required, tracheotomy can be used instead.