• Acute respiratory failure (Pao2 <
50 mm Hg in patient with fraction of inspired oxygen [Fio2] > 0.5 and Paco2 > 55 mm Hg).
• Need to control oxygen delivery (eg, institution of positive
end-expiratory pressure [PEEP], accurate delivery
of Fio2 > 0.5).
• Need to control ventilation (eg, to decrease work of breathing,
to control Paco2, to provide
• Inadequate chest wall function (eg, in patient
with Guillain-Barré syndrome, poliomyelitis).
• Absence of protective airway reflexes (eg, cough, gag).
• Glasgow Coma Score ≤ 8.
• Upper airway obstruction.
• Infectious processes (eg, epiglottis, croup).
• Trauma to the airway.
• Burns (concern for airway edema).
• Resuscitation bags.
• Masks (appropriate sizes for ventilation).
• Laryngoscope (blade, handle, bulb, battery).
• Endotracheal tubes (appropriate sizes, cuffed, uncuffed).
• Oropharyngeal airway.
• Tongue blade.
• Bite block.
• Tape (to secure tube).
• Stylet (appropriate sizes).
• CO2 detector device.
• Syringe to inflate the endotracheal tube balloon on cuffed tubes.
• Table 4–1 lists
the suggested sizes for endotracheal tubes.
• Uncuffed tubes are generally recommended in children younger
than 8 years, except in cases of severe lung disease.
• Handle with battery and blade with light source. Adult and
pediatric handles fit all blades, and differ only in handle diameter.
• A straight blade provides greater displacement of the tongue
into the floor of the mouth and visualization of a cephalad and
anterior larynx (Figure 4–1A).
• Table 4–2 lists the suggested
sizes of blades.
• If a difficult intubation is anticipated due to altered supraglottic
anatomy, absolutely no irreversible anesthetics or muscle relaxants
should be administered.
• Such patients should generally be intubated awake or in the
operating room with halothane.
• For difficult intubations, other techniques, such as fiberoptic
intubation, may be used.
Table 4–1. Suggested
endotracheal tube size.a |Favorite Table|Download (.pdf)
Table 4–1. Suggested
endotracheal tube size.a
|Age||Internal Diameter (mm)|
|6 months–12 months||3.5–4.0|
|12 months–2 years||4.0–4.5|
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