Intubation
As intubation introducing a is the tube ( latin for, tube '; plural : Tubusse, tubes, Tubi ; here is one which hollow probe' is meant) in a natural body cavity or in a hollow organ , respectively. Usually the term is used in the sense of inserting a tube through the mouth or nose into the throat or into the windpipe ( trachea ) for aspiration-protected ventilation ( securing the airways ). The term intubation is sometimes used to describe endoscopic procedures .
The removal of a ventilation tube is called extubation . The weaning and the transition to spontaneous breathing hot fachsprachlich weaning .
Types of intubation
Oropharyngeal tube
If a curved plastic tube (tube) is placed over the mouth (os) and into the throat ( pharynx ), one speaks of the oropharyngeal tube (also called oral or pharynx tube ; from Latin ōs and ancient Greek φάρυγξ phárynx ). It should keep the tongue away from the back of the pharynx and thus enable spontaneous breathing or ventilation with a resuscitator . The oropharyngeal tubes include the Guedel tube , COPA tube , Weinmann Lifeway and the Safar tube .
Nasopharyngeal tube
With the nasopharyngeal tube or nasopharyngeal tube according to Wendl ( Wendl tube ), the tube is placed through the nose and comes to rest in the throat like the oropharyngeal tubes. Accordingly, it is similar to the pharyngeal tubes in terms of advantages and disadvantages.
Endotracheal intubation
In the endotracheal intubation , a is the endotracheal tube through the mouth ( orotracheal ) or nose ( nasotracheal ) between the vocal cords of the larynx ( larynx therethrough) into the windpipe ( trachea introduced). A scale in centimeters is printed on the endotracheal tube . In adult humans, the tube is usually advanced up to a distance of 21 cm from the front teeth of the upper jaw ; this is deviated from for extremely small or extremely large people. This endotracheal intubation is carried out in patients under anesthesia , unconsciousness or acute respiratory disorders in order to secure the airways from aspiration and to enable ventilation . Since the anatomical conditions are different from person to person and, as a result, the anatomy of the oropharynx as well as the trachea and glottis, there is a classification according to Cormack and Lehane for classifying the difficulty of intubation - divided into four different grades becomes how well the glottis can be seen. There are various options for simplifying endotracheal intubation, such as the Sellick handle or the BURP maneuver . Intubation is now considered the standard method ( gold standard ) for securing the airway by the trained person; the term intubation is therefore often referred to in the narrower sense. The introduction of a tube with two lumens enables the lungs to be ventilated separately at the sides, which is required for some procedures in thoracic surgery . This is sometimes also described as endobronchial intubation , since the tip of the tube comes to rest in a main bronchus .
Video control
There is also a procedure in which a video laryngoscope is (also) used. In this case, the search for the way through the glottis into the windpipe is supported by the video view.
Alternatives to endotracheal intubation
Alternatives to endotracheal intubation (even for inexperienced users) are aids such as laryngeal masks , laryngeal tubes and combitubes , which are often used for ventilation during smaller operations, when the tube is inability to position correctly ( difficult intubation ), or by non-medical paramedics . In the resuscitation guidelines of the ERC from 2011 it is explicitly mentioned that inexperienced persons should use these alternatives to secure the airway in order to prevent incorrect intubation, i.e. the unnoticed insertion of the endotracheal tube into the esophagus with gastric overinflation. Using what is known as non - invasive ventilation (NIV) can in some cases avoid intubation.
If necessary, cut the airway
In urgent emergencies, when there is an acute threat of asphyxiation, a cricothyrotomy (incision of the larynx) or tracheotomy (incision of the windpipe) can create direct access (stoma) of the airway to the outside air.
literature
- Roche Lexicon Medicine. 5th, revised and expanded edition. Urban & Fischer at Elsevier, Munich / Jena 2003, ISBN 3-437-15180-0 .
- Rossaint, Werner, Zwissler (ed.): The anesthesiology. General and special anesthesiology, pain therapy and intensive care medicine. 2nd Edition. Springer, Berlin 2008, ISBN 978-3-540-76301-7 .
- Intensive care and anesthesia. Lothar Ullrich u. a. (Ed.). 2., rework. and exp. Edition. Thieme, Stuttgart / New York, NY 2010, ISBN 978-3-13-130912-9 .
Individual evidence
- ^ Markwart Michler, Jost Benedum : Introduction to medical terminology. 2nd Edition. Springer-Verlag, Berlin / Heidelberg / New York 1981, ISBN 3-540-10667-7 , p. 114.
- ↑ Willibald Pschyrembel: Clinical Dictionary . 117-122. Edition. De Gruyter, Berlin 1958, p. 893.
- ↑ Willibald Pschyrembel: Clinical Dictionary . 267th edition, De Gruyter, Berlin, Boston 2017, ISBN 978-3-11-049497-6 , p. 1938.
- ↑ Thomas Pasch , Christoph Mörgeli (ed.): 150 years of anesthesia. Anesthesia, intensive care medicine, pain therapy, emergency medicine. Abott AG, Cham, and Zeneca AG, Lucerne, Institute for Anaesthesiology of the University Hospital Zurich, Zurich 1997 ( sgar-ssar.ch ( Memento from June 27, 2015 in the Internet Archive ) [PDF; 2.2 MB]).
- ↑ Worker fell into the construction pit - condition critical orf.at, August 7, 2020, accessed August 7, 2020. - A report on the implementation of an intubation with the video laryngoscope.
- ↑ CD Deakin et al: European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation. 2010 Oct; 81 (10): 1305-52. doi: 10.1016 / j.resuscitation.2010.08.017 , PMID 20956049 .
- ^ Rolf Dembinski: Non-invasive forms of ventilation. In: Anesthesia & Intensive Care Medicine. Volume 60, June 2019, pp. 308-315, doi: 10.19224 / ai2019.308 ( ai-online.info [PDF; 189 kB]).
