Combitubus

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A Combitubus (manufacturer's name Combitube or modified Easytube ) is an aid for securing the airway and combines, consisting of two hollow probes, the functions of an esophageal occlusion tube and an endotracheal tube . It represents an alternative to endotracheal intubation and is mainly used in emergencies when the latter does not work. In this context, use is provided for in the guidelines of various medical specialist societies, such as in resuscitation . The Combitubus, however, does not play a role in routine clinical anesthesia . It was developed in Vienna in 1987.

construction

Combitubus

Like the endotracheal tube, the Combitubus consists of a flexible plastic tube that is open at both ends. In contrast to this, however, it contains two lumens and is provided with two cuffs (block cuffs for sealing) which can be inflated individually. The upper, proximal cuff surrounds the tube roughly in the middle, while the lower ( distal ) cuff is attached to the end. The proximal lumen ends between the cuffs and the distal lumen below the lower one. Ventilators can be connected to these at the outer end of the tube .

functionality

The Combitubus is inserted into the mouth and throat with the head in the neutral position until a ring mark comes to rest between the rows of teeth. Usually (more than 95% of cases) the tip is then in the esophagus ( esophagus ), in less than 5% of cases in the windpipe ( trachea ). The lower cuff is also located in the esophagus or trachea, the upper one in the pharynx. After blocking first the oropharyngeal cuff (with about 100 ml of air) and then the distal cuff (with about 10 ml), in most cases it is possible to ventilate through the proximal lumen, as the air is sealed up and down by the cuff, can flow through the larynx into the lungs. In cases in which the tube is located directly in the trachea, ventilation can be carried out via the distal lumen; the position and function then correspond to an endotracheal tube . The suitable lumen must be identified clinically (breathing sounds over the lungs) and technically ( capnometry , special oesophageal detector device ).

The structure and function of the combitube are similar to the laryngeal tube . This is also inserted without aids, but due to its construction it almost always comes to lie in the esophagus. It therefore has only one lumen that ends between the two cuffs.

Risks

The use of the Combitubus is demanding. If the device is inserted too deeply, both openings will come to rest in the esophagus and ventilation is impossible. In addition, the adapter is often mixed up.

Even with the correct position, complications can arise. The most common problem is aspiration of stomach contents with subsequent pneumonia , as the seal through the cuff in the esophagus is often insufficient. Injuries to the mouth, larynx or esophagus are also possible, which can lead to pneumothorax and skin emphysema .

literature

  • Walied Abdulla: Interdisciplinary Intensive Care Medicine. Urban & Fischer, Munich a. a. 1999, ISBN 3-437-41410-0 , p. 9.

Individual evidence

  1. ↑ JP Nolan, CD Deakin, J. Soar et al: European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. In: Resuscitation. 67 Suppl 1, 2005, pp. S39-S86. PMID 16321716 .
  2. ↑ a b c K. Gerlach, V. Dörges, T. Uhlig: The difficult airway. In: AINS. 41 (2), Feb 2006, pp. 93-118. PMID 16493561
  3. ↑ M. Frass , R. Frenzer, J. payers, W. Ilias, C. Leithner: ventilation via the esophageal tracheal COMBITUBE in a case of difficult intubation. In: J Cardiothorac Anesth. 1 (6), Dec 1987, pp. 565-568. PMID 17165357
  4. ↑ EB Liem: Combitube Intubation. University of Florida Department of Anesthesiology, Center for Simulation, Advanced Learning and Technology, 2006. Virtual Anesthesia Machine Web site: http://vam.anest.ufl.edu/airwaydevice/combitube/index.html
  5. ↑ MC Vézina, CA Trépanier, PC Nicole, MR Lessard: Complications associated with the Esophageal-Tracheal Combitube in the pre-hospital setting. In: Can J Anaesth. 54 (2), Feb 2007, pp. 124-128. PMID 17272251

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