Airway management is one of the most important tools that providers have in a surgical or critical care setting. Intubation is a powerful form of airway management and can be a lifesaving procedure—but it can also lead to complications.
In an ideal scenario, providers will have a range of advanced airway management technologies available to provide the best patient care during intubation and extubation. In this blog, we’ll explore the latest tools and trends in airway management.
The Basics of Intubation and Extubation
There are many reasons why a patient may need to be intubated, including if their airway is obstructed, if they’re experiencing respiratory failure, or if they’re undergoing surgery.
Intubation is the process of inserting a tube through a patient’s mouth or nose and down the trachea to keep the patient’s airway open. The patient receives airflow to their lungs through a bag-valve device or a mechanical ventilator.
Conversely, extubation is the process of removing the tube from a patient’s airway so that the patient is no longer dependent on mechanical ventilation. The patient can either be “weaned,” meaning they’re gradually transitioned from total ventilation support to partial support, or “liberated,” meaning they’re immediately removed from ventilation support.
Intubation and extubation can be challenging for many patients, but the right tools can keep complications in airway management to a minimum.
Advanced Tools for Intubation
Providers can choose from a range of tools for airway management depending on the patient’s needs, the difficulty of the airway, and the urgency of the situation.
Intubating with an endotracheal (ET) tube is the gold standard airway management technique. An ET tube dramatically reduces risk of aspiration while offering reliable ventilation. However, ET tubes are more difficult to place and therefore have a higher risk of complications.
Video laryngoscopes offer advanced visualization technology that gives providers a clear and enlarged view of the airway. This is especially helpful for patients with a difficult airway and has been shown to lead to fewer failed intubations when compared to traditional laryngoscopes.
Laryngeal mask airways (LMAs) are a less invasive option with a relatively easy insertion process that requires less anesthesia than ET tubes. LMAs generally lower the risk of sore throat, excessive coughing, and gagging in patients. In turn, recovery is often faster and more comfortable with the use of LMAs. (Read more about how LMAs improve patient comfort and safety in our previous blog post.)
Enhanced Monitoring and Visualization
In almost any circumstance, intubation is a technically difficult process that requires considerable experience for a successful outcome.
Real-time monitoring with tools like capnography—continuous end-tidal carbon dioxide monitoring—can confirm that an ET tube has been placed correctly. Capnography can also quickly detect if an ET tube has been dislodged, which can decrease the likelihood of inadvertent hypo- and hyperventilation.
In recent years, ultrasound has become one of the best tools at providers’ disposal to confirm endotracheal intubation with real-time images. Ultrasound offers fast and effective confirmation of successful placement, and it can also help redirect the ET tube quickly when misplacement occurs.
Improved Patient Comfort
Patient comfort during intubation is especially difficult to achieve, but advanced airway management techniques have made strides in terms of patient comfort.
LMAs in particular offer a more comfortable patient experience when appropriate, as they tend to minimize the complications typically associated with intubation. Patients emerging from anesthesia generally tolerate LMAs better than ET tubes and experience lower rates of coughing, laryngospasm, and breath holding.
Extubation Techniques and Challenges
Extubation comes with its own set of challenges. Extubation failure can contribute to increased risk of mandatory ventilation and mortality. On top of that, 10 to 20% of patients who are extubated need to be re-intubated within 48 hours.
However, the right tools can make all the difference for a successful extubation. In many cases, providers can exchange an ET tube for an LMA to make the extubation process smoother and more comfortable before the patient is completely liberated from the ventilator.
As airway management technologies continue to evolve, we expect to see even more improvements in patient comfort and outcomes. Current advanced airway management tools make intubation and extubation faster, more precise, and more successful—all of which point to better outcomes for the patient overall.
For more information about SourceMark’s advanced airway management tools or our other innovative solutions, contact a member of our team.