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Respiratory

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  • • Apnea.

    • 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 muscle relaxation).

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Neurologic

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  • • Inadequate chest wall function (eg, in patient with Guillain-Barré syndrome, poliomyelitis).

    • Absence of protective airway reflexes (eg, cough, gag).

    • Glasgow Coma Score ≤ 8.

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Airway

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  • • Upper airway obstruction.

    • Infectious processes (eg, epiglottis, croup).

    • Trauma to the airway.

    • Burns (concern for airway edema).

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Absolute

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  • • Nasotracheal intubation is contraindicated in patients with nasal fractures or basilar skull fractures.

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  • • Suction.

    • • Should have a tonsil-tipped suction device or a large-bore suction catheter as well as a suction catheter of appropriate size that fits into the endotracheal tube.

    • Oxygen.

    • Resuscitation bags.

    • Masks (appropriate sizes for ventilation).

    • Laryngoscope (blade, handle, bulb, battery).

    • Endotracheal tubes (appropriate sizes, cuffed, uncuffed).

    • Forceps.

    • 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.

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  • • Desaturation.

    • Bradycardia.

    • Inability to intubate.

    • Tracheal tear or rupture.

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  • 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.

    • Laryngoscopes.

    • • 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).

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    • • A curved blade may be used in the older child; the broader base and flange allow easier displacement of the tongue (Figure 4–1B).

    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.

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Table Graphic Jump Location
Table 4–1. Suggested endotracheal tube size.a
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Figure 4–1.
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