A tracheal tube is a
catheter
In medicine, a catheter (/ˈkæθətər/) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgi ...
that is inserted into the
trachea
The trachea, 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 air- breathing animals with lungs. The trachea extends from the ...
for the primary purpose of establishing and maintaining a patent airway and to ensure the adequate
exchange
Exchange may refer to:
Physics
*Gas exchange is the movement of oxygen and carbon dioxide molecules from a region of higher concentration to a region of lower concentration. Places United States
* Exchange, Indiana, an unincorporated community
* ...
of
oxygen
Oxygen is the chemical element with the symbol O and atomic number 8. It is a member of the chalcogen group in the periodic table, a highly reactive nonmetal, and an oxidizing agent that readily forms oxides with most elements as ...
and
carbon dioxide
Carbon dioxide ( chemical formula ) is a chemical compound made up of molecules that each have one carbon atom covalently double bonded to two oxygen atoms. It is found in the gas state at room temperature. In the air, carbon dioxide is trans ...
.
Many different types of tracheal tubes are available, suited for different specific applications:
* An endotracheal tube is a specific type of tracheal tube that is nearly always inserted through the mouth (orotracheal) or nose (nasotracheal).
* A tracheostomy tube is another type of tracheal tube; this curved metal or plastic tube may be inserted into a tracheostomy stoma (following a
tracheotomy
Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the trachea (windpipe). The r ...
) to maintain a patent lumen.
* A tracheal button is a rigid plastic cannula about 1 inch in length that can be placed into the tracheostomy after removal of a tracheostomy tube to maintain patency of the lumen.
History
Portex Medical (England and France) produced the first cuff-less plastic 'Ivory' endotracheal tubes.
Ivan Magill
Sir Ivan Whiteside Magill KCVO (23 July 188825 November 1986) was an Irish-born anaesthetist who is famous for his involvement in much of the innovation and development in modern anaesthesia. He helped to establish the Association of Anaestheti ...
later added a cuff (these were glued on by hand to make the famous Blue-line tube copied by many other manufacturers). Maeterlinck GmbH developed the disposable endotracheal tube and produced many design variations, adding the 'Murphy Eye' to their tubes in case of 'accidental' placement of the tube to avoid right bronchial occlusion.
David S. Sheridan David S. Sheridan (10 July 1908, Brooklyn – 29 April 2004, Argyle, New York) was the inventor of the "disposable" plastic endotracheal tube.
David was the second of six sons of Adolf and Anna Sockolof, who immigrated to the United States from Ru ...
was one of the manufacturers of the American markets "disposable" plastic tracheal tube now used routinely in surgery. Previously, red rubber (Rusch-Germany) tubes were used, then sterilized for re-use.
Applications
Tracheal tubes can also be used to deliver oxygen in higher concentrations than found in air, or to administer other gases such as
helium
Helium (from el, ἥλιος, helios, lit=sun) is a chemical element with the symbol He and atomic number 2. It is a colorless, odorless, tasteless, non-toxic, inert, monatomic gas and the first in the noble gas group in the periodic table. ...
,
nitric oxide,
nitrous oxide
Nitrous oxide (dinitrogen oxide or dinitrogen monoxide), commonly known as laughing gas, nitrous, or nos, is a chemical compound, an oxide of nitrogen with the formula . At room temperature, it is a colourless non-flammable gas, and has ...
,
xenon
Xenon is a chemical element with the symbol Xe and atomic number 54. It is a dense, colorless, odorless noble gas found in Earth's atmosphere in trace amounts. Although generally unreactive, it can undergo a few chemical reactions such as the ...
, or certain volatile anesthetic agents such as
desflurane,
isoflurane
Isoflurane, sold under the brand name Forane among others, is a general anesthetic. It can be used to start or maintain anesthesia; however, other medications are often used to start anesthesia rather than isoflurane, due to airway irritation w ...
, or
sevoflurane
Sevoflurane, sold under the brand name Sevorane, among others, is a sweet-smelling, nonflammable, highly fluorinated methyl isopropyl ether used as an inhalational anaesthetic for induction and maintenance of general anesthesia. After desflura ...
. Tracheal tubes may also be used as a route for administration of certain medications such as
salbutamol,
atropine,
epinephrine,
ipratropium
Ipratropium bromide, sold under the trade name Atrovent among others, is a type of anticholinergic (SAMA: short acting muscarinic antagonist) medication which opens up the medium and large airways in the lungs. It is used to treat the symptoms ...
, and
lidocaine. Tracheal tubes are commonly used for
airway management in the settings of
general anesthesia
General anaesthesia (UK) or general anesthesia (US) is a medically induced loss of consciousness that renders the patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general ...
, critical care,
mechanical ventilation
Mechanical ventilation, assisted ventilation or intermittent mandatory ventilation (IMV), is the medical term for using a machine called a ventilator to fully or partially provide artificial ventilation. Mechanical ventilation helps move a ...
, and emergency medicine.
Endotracheal tube
![Carlens](https://upload.wikimedia.org/wikipedia/commons/a/a8/Carlens.jpg)
Most endotracheal tubes today are constructed of
polyvinyl chloride, but specialty tubes constructed of
silicone rubber,
latex rubber, or
stainless steel are also widely available. Most tubes have an inflatable cuff to seal the trachea and
bronchial tree against air leakage and aspiration of gastric contents, blood, secretions, and other fluids. Uncuffed tubes are also available, though their use is limited mostly to pediatric patients (in small children, the
cricoid cartilage
The cricoid cartilage , or simply cricoid (from the Greek ''krikoeides'' meaning "ring-shaped") or cricoid ring, is the only complete ring of cartilage around the trachea. It forms the back part of the voice box and functions as an attachment si ...
, the narrowest portion of the pediatric airway, often provides an adequate seal for mechanical ventilation).
Types of endotracheal tubes include oral or nasal, cuffed or uncuffed, preformed (e.g. RAE (Ring, Adair, and Elwyn) tube), reinforced tubes, and double-lumen endobronchial tubes. For human use, tubes range in size from 2 to 10.5 mm in internal diameter (ID). The size is chosen based on the patient's body size, with the smaller sizes being used for pediatric and neonatal patients. Tubes larger than 6 mm ID usually have an inflatable cuff. Originally made from red
rubber
Rubber, also called India rubber, latex, Amazonian rubber, ''caucho'', or ''caoutchouc'', as initially produced, consists of polymers of the organic compound isoprene, with minor impurities of other organic compounds. Thailand, Malaysia, an ...
, most modern tubes are made from
polyvinyl chloride. Those placed in a laser field may be flexometallic. Robertshaw (and others) developed
double-lumen endo-bronchial tubes for
thoracic surgery
Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart (heart disease), lungs (lung disease), and other pleural or mediastinal stru ...
. These allow
single-lung ventilation while the other lung is collapsed to make surgery easier. The deflated lung is re-inflated as surgery finishes to check for fistulas (tears). Another type of endotracheal tube has a small second lumen opening above the inflatable cuff, which can be used for suction of the nasopharngeal area and above the cuff to aid extubation (removal). This allows suctioning of secretions that sit above the cuff which helps reduce the risk of chest infections in long-term intubated patients.
The "armored" endotracheal tubes are cuffed, wire-reinforced, silicone rubber tubes that are quite flexible but yet difficult to compress or kink. This can make them useful for situations in which the trachea is anticipated to remain intubated for a prolonged duration, or if the neck is to remain flexed during surgery. Polyvinyl chloride tubes are relatively stiff in comparison. Preformed tubes (such as the oral and nasal RAE tubes, named after the inventors Ring, Adair and Elwyn) are also widely available for special applications. These may also be constructed of polyvinyl chloride or wire-reinforced silicone rubber. Other tubes (such as the Bivona Fome-Cuf tube) are designed specifically for use in laser surgery in and around the airway. Various types of double-lumen endotracheal (actually, endobronchial) tubes have been developed (Carlens,
White, Robertshaw, etc.) for ventilating each lung independently—this is useful during pulmonary and other thoracic operations.
Tracheostomy tube
Several types of tracheostomy tubes are available, depending on the requirements of the patient, including Shiley, Bivona (a silicon tube with metal rings that are good for airways with damage to the tracheal rings or otherwise not straight), and fenestrated.
Tracheal button
A tracheal button is generally used in people with severe
obstructive sleep apnea, who often wear this device during waking hours and remove it while sleeping to ensure a patent airway and reduce the risk of asphyxiation. Since the tube does not extend far into the trachea, it is easy to breathe and speak with the device in place.
See also
*
Laryngeal tube
*
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 frequentl ...
*
Airway management
References
Further reading
*
Alt URL
External links
ACLS algorithmswith manual that includes further tracheal tube information.
{{DEFAULTSORT:Tracheal Tube
Airway management
Medical equipment