ENDOTRACHEAL TUBES

These are either disposable portex tubes or reusable rubber tubes. They are used for intubation to maintain the airway in case of cardio-respiratory arrest to create artificial ventilation. In neonates also, it is used in the treatment of meconium aspiration syndrome. It is used in treatment of respiratory failure due to various causes to maintain artificial respiration.

Both the portex and rubber tubes come in cuffed and non-cuffed varieties. Cuffed tubes are available as high-pressure low volume cuffs and as low- pressure high volume cuffs. The cuffed ET tubes help to prevent aspiration of materials into the trachea, maintain the position of the ET & prevent its dislodgment and create an airtight passage, which is very important for IPPR. There are permanently attached cuffs and slip on cuffs also available. Cuffed tubes are used in children above 8 years and in those children who require more then 6 no. Tube. Cuffed tubes may cause pressure necrosis on the tracheal mucosa; hence, a pilot balloon is usually attached to serve as an indication for the amount of inflation.

Endotracheal tubes come in various sizes in increasing units of 0.5. In the full term neonates 3.0 Fr tubes is usually required. The sizes of the tubes require for intubation can be calculated from the formula.

Size of tube = y/4+4

Where ‘y’ is the age in years.

In adults, 8.5-size tube is usually required.

The length of the tube to be inserted is up to the black mark present on the distal end of the tube which should approximate with the vocal cords.

Intubation can be done both through the oral and the nasal route. However there are different tubes available for different methods as the radius of curvature differs in both orotracheal intubation and nasotracheal intubation.

Endotracheal intubation thought life saving is also not without its complications. There is always a risk of trauma to the local structures, endobronchial intubation, aspiration of the tubes and blockage of the endotracheal tube. Long term intubation may lead to ulceration, tracheal stenosis and vocal cord paralysis.

Portex tube comes in a pre-sterilized pack to be used only once and hence is more expensive. But it can be used for a longer time in the patient. Rubber tube can be reused and can be sterilized by boiling, autoclaving or gas sterilization. However, it can not be used for more than 24 hours in a patient.
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