- there are numerous modified versions of endotracheal tubes used in critical care, this page describes the features of a standard endotracheal tube
- securing of airway and provision of mechanical ventilation
METHOD OF INSERTION AND/OR USE
- choose appropriate size for patient (the size refers to the internal diameter, ID)
- eg. adult female 7.5mm, adult male 8.5mm; but varies with the individual
- child less than 10 years old: size = age/4 + 4
- check cuff integrity
- lubrication (if required)
- decide on an appropriate technique for intubation
- laryngoscopy (visualisation of the cords)
- placement of ETT through vocal cords until indicator mark just below cords
- inflation of cuff
- check: tube fogging, chest rising and falling, ETCO2
- universal 15mm connector
- clear non-toxic plastic
- low profile, high volume, low pressure cuff -> decrease risk of pressure necrosis
- radio-opaque strip -> can be seen on CXR
- Murphy eye -> even if ETT is in too far there is a chance of ventilating right main bronchus
- high beveled atraumatic tip
- latex free
- 2cm indicator mark assists positioning of tube past vocal cords
- early: difficult/failed intubation, trauma, bleeding, cuff perforation, endobronchial intubation
late: tracheal mucosal necrosis, stenosis
References and Links
FOAM and web resources
- howequipmentworks.com — endotracheal tubes (excellent basic overview of features of standard ETT and different types of ETT, with useful photographs and diagrams)
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.