Tracheal intubation in the context of Positive pressure ventilation


Tracheal intubation in the context of Positive pressure ventilation

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⭐ Core Definition: Tracheal intubation

Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the trachea (windpipe) to maintain an open airway or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill, or anesthetized patients to facilitate ventilation of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction.

The most widely used route is orotracheal, in which an endotracheal tube is passed through the mouth and vocal apparatus into the trachea. In a nasotracheal procedure, an endotracheal tube is passed through the nose and vocal apparatus into the trachea. Other methods of intubation involve surgery and include the cricothyrotomy (used almost exclusively in emergency circumstances) and the tracheotomy, used primarily in situations where a prolonged need for airway support is anticipated.

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👉 Tracheal intubation in the context of Positive pressure ventilation

Positive airway pressure (PAP) is a mode of respiratory ventilation used in the treatment of sleep apnea. PAP ventilation is also commonly used for those who are critically ill in hospital with respiratory failure, in newborn infants (neonates), and for the prevention and treatment of atelectasis in patients with difficulty taking deep breaths. In these patients, PAP ventilation can prevent the need for tracheal intubation, or allow earlier extubation. Sometimes patients with neuromuscular diseases use this variety of ventilation as well.

Variations include continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP). BPAP has two pressure settings: the prescribed pressure for inhalation (ipap), and a lower pressure for exhalation (epap); the dual settings allow the patient to get more air in and out of their lungs.

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Tracheal intubation in the context of Mannequin

A mannequin (sometimes spelled as manikin and also called a dummy, lay figure, or dress form) is a doll, often articulated, used by artists, tailors, dressmakers, window dressers and others, especially to display or fit clothing and show off different fabrics and textiles. Alternatively the term refers, or referred to, a live human fashion model.

Life-sized mannequins with simulated airways are used in the teaching of first aid, CPR, and advanced airway management skills such as tracheal intubation. During the 1950s, mannequins were used in nuclear tests to help show the effects of nuclear weapons on humans. Also referred to as mannequins are the human figures used in computer simulation to model the behavior of the human body.

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Tracheal intubation in the context of Trachea

The trachea (pl.: tracheae or tracheas), also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all animals' lungs. The trachea extends from the larynx and branches into the two primary bronchi. At the top of the trachea, the cricoid cartilage attaches it to the larynx. The trachea is formed by a number of horseshoe-shaped rings, joined together vertically by overlying ligaments, and by the trachealis muscle at their ends. The epiglottis closes the opening to the larynx during swallowing.

The trachea begins to form in the second month of embryo development, becoming longer and more fixed in its position over time. Its epithelium is lined with column-shaped cells that have hair-like extensions called cilia, with scattered goblet cells that produce protective mucins. The trachea can be affected by inflammation or infection, usually as a result of a viral illness affecting other parts of the respiratory tract, such as the larynx and bronchi, called croup, that can result in a cough. Infection with bacteria usually affects the trachea only and can cause narrowing or even obstruction. As a major part of the respiratory tract, the trachea, when obstructed, prevents air from entering the lungs; thus, a tracheostomy may be required. Additionally, during surgery, if mechanical ventilation is required during anaesthesia, a tube is inserted into the trachea: this is called tracheal intubation.

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Tracheal intubation in the context of Noninvasive ventilation

Non-invasive ventilation (NIV) is the use of breathing support administered through a face mask, nasal mask, or a helmet. Air, usually with added oxygen, is given through the mask under positive pressure; generally the amount of pressure is alternated depending on whether someone is breathing in or out. It is termed "non-invasive" because it is delivered with a mask that is tightly fitted to the face or around the head, but without a need for tracheal intubation (a tube through the mouth into the windpipe). While there are similarities with regard to the interface, NIV is not the same as continuous positive airway pressure (CPAP), which applies a single level of positive airway pressure throughout the whole respiratory cycle; CPAP does not deliver ventilation but is occasionally used in conditions also treated with NIV.

Non-invasive ventilation is used in acute respiratory failure caused by a number of medical conditions, most prominently chronic obstructive pulmonary disease (COPD); numerous studies have shown that appropriate use of NIV reduces the need for invasive ventilation and its complications. Furthermore, it may be used on a long-term basis in people who cannot breathe independently as a result of a chronic condition.

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Tracheal intubation in the context of Intubation

Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Most commonly, intubation refers to tracheal intubation, a procedure during which an endotracheal tube is inserted into the trachea to support patient ventilation. Other examples of intubation include balloon tamponade using a Sengstaken–Blakemore tube (a tube into the gastrointestinal tract), urinary catheterization, and nasogastric intubation using a feeding tube.

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Tracheal intubation in the context of Cricothyrotomy

A cricothyrotomy (also called cricothyroidotomy or laryngotomy) is a medical procedure where an opening is created through the cricothyroid membrane to establish a patent airway during emergency airway management. Cricothyrotomy is primarily performed as the last step in airway management algorithms in cases where an airway cannot be established by other means of nasal or oral tracheal intubation. These situations, often referred to as "cannot intubate, cannot ventilate" (CICV) or "cannot intubate, cannot oxygenate" (CICO), are commonly seen as a result of airway obstruction, angioedema, trauma, burns, or abnormal anatomy.

Multiple types of cricothyrotomy may be considered for emergency surgical airway management, including surgical cricothyrotomy and needle cricothyrotomy. Surgical cricothyrotomy is performed by inserting a large-bore tube through an opening in the cricothyroid membrane created via incision or using the Seldinger technique. Needle cricothyrotomy is performed by inserting a catheter through the cricothyroid membrane and connecting it to a ventilation bag or a high-pressure oxygen source in a process called transtracheal jet ventilation. Various cricothyrotomy techniques have been portrayed in popular media but should only be performed by trained medical professionals.

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