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INDICATIONS FOR ENDOTRACHEAL INTUBATION

Indications for ENDOTRACHEAL INTUBATION in the operating room
include:

The need to deliver positive pressure ventilation

Protection of the respiratory tract from aspiration of gastric contents
Surgical procedures involving the head and neck or in non-supine
positions that preclude manual airway support
Almost all situations involving neuromuscular paralysis
Surgical procedures involving the cranium, thorax, or abdomen
Procedures that may involve intracranial hypertension

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Some non-operative indications are:

Profound disturbance in consciousness with the inability to protect

the airway
Tracheobronchial toilet
Severe pulmonary or multisystem injury associated with
respiratory failure, such as sepsis, airway obstruction, hypoxemia,
and hypercarbia

The main indication for intubation is airway protection / control of

airway:

1. Loss of gag/cough reflex e.g. head injury with GCS <8 (to prevent
massive aspiration).
2. Airway obstruction: acute laryngeal edema e.g. inhalation burn,
Ludwigs angina, epiglottitis.
3. Anticipated loss of control of the airway: anticipated laryngeal edema
e.g. neck trauma, acute stridor etc.

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Indications for mechanical ventilation:

Ventilation Failure

Oxygenation Failure

Failure to Ventilate

Characterized by reduced alveolar ventilation which manifests as an increase in the

PaCO2 > 50 mmHg.
Neurological Problems
Central: loss of ventilatory drive due to sedation, narcosis, stroke or brain injury.
Spinal: spinal cord injury,
injury cervical loss of diaphragmatic function,
function thoracic loss of
intercostals.
Peripheral: nerve injury (e.g. phrenic nerve in surgery), Guillain-Barre syndrome
(demyelination), poliomyelitis, motor neurone disease.
Muscular Problems
Myopathic disorders myasthenia gravis, steroid induced myopathy, protein
malnutrition.
Anatomical Problems
Chest Wall rib fractures or flail chest,, obesity,
y, abdominal hypertension,
yp
, restrictive
dressings
Pleura pleural effusions, pneumothorax, hemothorax.
Airways airway obstruction (in lumen, in wall, outside wall), laryngeal edema,
inhalation of a foreign object, bronchospasm.
Gas Exchange Problems
Ventilation perfusion mismatch, particularly increased alveolar deadspace (often due
to hyperventilation), acute lung injury (ALI), lung contusion.

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Failure to Oxygenate
Diffusion abnormality
Ventilation/Perfusion Mismatch
Shunt
Inability to extract at cellular level sepsis, cyanide or carbon
monoxide poisoning

IN SUMMARY
Indications for tracheal intubation:

Obtain & Maintain AW

Correct Gas exchange
Protect from aspiration
Predict