Endotracheal tube
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An endotracheal tube (ETT) is used in anaesthesia, intensive care and emergency medicine for airway management and mechanical ventilation.
Procedure
It is inserted into the trachea, generally via the mouth, but sometimes through the nares of the nose (e.g. in extensive mouth surgery) or even through a tracheostomy. The process of inserting a ETT is called intubation.
Intubation usually requires general anaesthesia and muscle relaxation but can be achieved in the awake patient with local anaesthesia or in an emergency without any anaesthesia. It is usually performed by visualising the larynx by means of a hand-held laryngoscope but can also be performed "blind". A stylet is normally used in a intubation which is a bendable piece of metal inserted into the ETT as to make the tube more stiff for easier insertion, this is then removed after the intubation and a ventilator or bag valve mask is attached to the ETT. The goal is to position the end of the ETT 2 centimeters above the biforcation of the lungs or the carina. If inserted too far into the trachea it mainly goes into the right mainstem of the bronchial tree.
Endotracheal tubes are irritating and extremely uncomfortable to insert in a fully conscious, unanesthetised patient.
It is the most reliable available method for protecting a patient's airway.
Types
There are many types of Endotracheal tubes(ETT). Endotracheal tubes range in size from 3-9 mm in internal diameter (ID) - different sizes are chosen based on the patient's body size with the smaller sizes being used for pediatric and neonatal patients. Tubes larger than 6mm ID tend to have an inflatable cuff. Special double-lumen endotracheal tubes have been developed for lung and other intra-thoracic surgery. These tubes allow one-lung ventilation while the other lung can be collapsed to make surgery easier. Another type of endotracheal tube has a second lumen which the opening is situated right above the inflatable cuff, this is a suction port. This allows a suction system to be connected to the ETT to allow for suctioning of secretions which sit above the cuff. This has been proven to decrease the about bacteria which could possible grow in the secretions causing a longer stay in the hospital.