Artificial Airways

Dr. Abhijit Diwate

Cardio-Vascular & Respiratory PT
DVVPF College of Physiotherapy,
Ahmednagar 414111
 Artificial Airways

• Purpose:

Lift the tongue & epiglottis away

from the posterior pharyngeal wall &
prevent them from obstructing the
space above larynx
 Objectives
• Oropharyngeal

• Nasopharyngeal

• Endotracheal Tubes

• Tracheostomy tubes
 Oropharyngeal Airway
Indications
– Maintain airway in the unconscious
patient
– Protects an Endotracheal Tube from
being bitten
– Facilitates Airway Suctioning
Guedal Airway
 Berman Airway

• It has a center support &

open sides

• Has a flange at the buccal

end
 Ovassapian Airway
• The Ovassapian airway is used to facilitate
fiber-optic intubation.

• Overall shape is similar to a Geudal airway,

but is open on the top

• A tubular shaped guide in the center

facilitates passage of fiber-optic
laryngoscope.
Williams Intubating Airway
• This is designed to facilitate
fiber-optic intubation.

• It is similar in profile to the

guedal airway, it is open on
the distal half, and cylindical
at the proximal portion.

• It is only available in 2 sizes

9 cm and 10 cm.
Cuffed Oro-phayrngeal Airway
(COPA)
• A Guedal airway with an
inflatable cuff to seal the
oropharynx

• A 15 mm connector to attach
to breathing circuit

• Cuff inflated with 25 to 40 cc

air
 LT Oro pharyngeal Airway
• This has a 15 mm adaptor for
connection to the anesthesia
circuit.

• Come in different sizes and are

color coded.

• They are not available in

pediatric sizes.
 Nasopharyngeal Airway
Indications
– Airway maintenance
• Oral Airway placement difficult
– Nasotracheal intubation
guide in maxillofacial trauma
Complications
– Esophageal intubation (if too
long)
– Laryngospasm
– Vomiting
– Nasal mucosa injury and
secondary blood aspiration
ENDOTRACHEAL
TUBES
 Determining Sizes

Internal Diameter (ID)

• Newborns
<28 wks (<1000 g): 2.5 mm
28-34 wks (1000-2000 grams): 3.0 mm
34-38 wks (2000-3000 grams): 3.5 mm
>38 wks (>3000 grams): 3.5 to 4.0 mm
Intermediate Tracheal Tube
• Excellent for oral and nasal
intubations where a shorter
cuff is desired

• Features:
– Murphy tip and eye
– Tip-To-Tip radiopaque
line
– Pilot balloon and
mechanical self-sealing
valve
 Tracheal Tube
• Meets the guidelines of
the cuff criteria.

• Thin cuff conforms to

uneven tracheal
surfaces to create low
pressure seal.

• Large cuff diameter of 1-

1/2 times the average
trachea maintains proper
low-pressure seal
 COLE TRACHEAL TUBE
• Patient end smaller than rest of
tube

• Sized according to the ID of the

tracheal portion

• Widened portion should not contact

larynx

• Cannot be used nasally as the wide

segment will not pass through nares
Evac Endotracheal Tube with
Evacuation Lumen
Convenient and safe
method for suctioning
accumulated secretions
in the subglottic space

Low VAP incidence

Useful for gas sampling,

airway pressure
monitoring, giving drugs
& jet ventilation
Jet Tracheal Tube
• Features:
– Magill curve
– Uncuffed

• Includes:
– Main Lumen for
ventilation

– Insufflation lumen
permits the delivery of
jet ventilation
Endobronchial double lumen tube
With CPAP System
• Improves oxygenation
during one-lung anesthesia.

• Anesthesia bag to aid

opening alveoli.

• Adjustable valve supplies

pressures in clinical
settings from 1 to 10cm
H20.
Oral Ring Adair Elwin tracheal Tube
• Preformed curve removes
circuit from surgical field.

• Unique design assures

patent airway while reducing
risk of kinks and
disconnects.

• Rectangular mark at
preformed curve aids
correct positioning.
Nasal RAE Tracheal Tube
 Indications
• Nasal surgery & Facial surgery

• Ophthalmic surgery

• Prone positioning
 Laser – Flex Tracheal Tube
• Stainless steel body is
airtight, flexible and laser-
resistant.

• Reflected beams from the

tube are defocused to
reduce accidental laser
strikes to healthy tissue.

• Smooth surface and Magill

curve minimize trauma
during intubation.
Combitube
 Features
• For difficult or emergency intubation.

• Blind placement without laryngoscope.

• Unique design provides patent airway with

either esophogeal or tracheal placement.

• Reduces risk of aspiration of gastric

contents.
Lo-Contour Tracheal Tube
• Cuff lies close to the tube
while deflated for better
view of vocal cords

• Translucent white tube is

easy to see in trachea

• Adequate cuff diameter

provides low-pressure
seal.
ET Tube with Controllable Tip

• Loop controls the

direction of the tip

• Radius of curvature is
reduced by pulling the
loop

• Useful in blind intubations

Reinforced Tracheal Tube

• Soft, flexible PVC tube

with spiral-wound
reinforcing wire

• Reduced risk of kinking.

• Reinforcing wire is
sealed tightly against
bonded connector.
Tube with Lanz Pressure Regulating
Valve
• Reduces risk of
tracheal damage
during long-term
intubations.

• Lanz valve reduces

the need for manual
cuff pressure
monitoring.
 Microlaryngeal Tracheal Tube

• Small cuff size & I.D. and O.D.

provide greater access

• ID of 4, 5 or 6 mm only

• Cuff diameter: that of 8 mm

tube

• Used when airway has been

narrowed by a tumor or other
Preformed Laryngectomy
Tube
Uncuffed Tracheal Tube
• Wide range of pediatric
sizes

• Provides better fit even for

premature infants.

• Distal tip reference lines

and depth marks

• Thin, but strong tube wall

provides maximum inner
diameter for proper
ventilation.
Uncuffed Tracheal Tube with
Monitoring Lumen
Tracheostomy
Tubes
 J Shaped Tracheostomy Tubes
• Available in larger sizes for
patients with a tracheostomy.

• The short portion of the J is

inserted into the trachea, and
the long portion lies flat
against the chest

• Reduces risk of accidental

disconnection/extubation
 Summary

• Oropharyngeal airways

• Nasopharyngeal airways

• Endotracheal Tubes

• Tracheostomy tubes
 QUESTIONS

1. WRITE ABOUT THE J SHAPED

TRACHEOSTOMY TUBES. 3MARKS
2. WRITE ABOUT ENDOTHECAL
TUBES. 7MARKS
Thank you