airway complications of intubation

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Airway Complications of Intubation. Complications of Mechanical Ventilation. Complications related to Intubation Mechanical complications related to presence of ETT Ventilator induced lung injury Complications related to Oxygen Infectious complications of mechanical ventilation. Competence - PowerPoint PPT Presentation

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  • Airway Complications of Intubation

  • Complications of Mechanical VentilationComplications related to IntubationMechanical complications related to presence of ETTVentilator induced lung injuryComplications related to OxygenInfectious complications of mechanical ventilation

  • CompetenceConfidenceUnable to Open MouthTrismusSmall mouthPeri-oral scarringFascial sweallingUnable to insert laryngoscopeShort neckLarge chestProminent upper incisorsSmall mandibleEdemaUnable to see glottisFixed position of the headSmall jawAnterior larynxObstructed by blood or vomitUnable to pass tube into tracheaFixed Unrecognizable glottisToo small glottis or sub-glottic diameteVulnerability to complicationsFixed Full stocmachHypovolemiaHypotensionHypoxemiaHypercarbiaAgitationAge and sexTraumaEndobronchial intubationEsophageal intubationSevere hypoxiaSevere hypotensionDeath

    EnvironmentNo skilled helpNo specialized equipmentsMissing of defective equipmentPoor positioningDifficult Intubation

  • Injuries to Face, Lips and Oro-pharynxTrauma to the lips and cheeks from tube tiesPeri-oral herpesInjuries to the tongue especially if entrapped between the endotracheal tube and the lower teethPressure ulcers to the palate and oropharynx

  • Maxillary Sinus and Middle Ear EffusionMaxillary effusion 20% in patients intubated for > 7 days.47% when the gastric tube is placed nasally95%Secondarily infected maxillary effusion (45-71% of effusions)Middle ear effusion (29%) with 22% of them become infectedHearing impairment that may contributes to the confusion and delirium in elderly population

  • Laryngeal InjuriesSome degree of glottic injury is seen in 94% of patients intubated for 4 days or longerErosive ulcers of vocal cords (posterior commissures)Swelling and edema of the vocal cordsGranulomas (7% in patients intubated for 4 days or more)

  • Pharyngo-laryngeal DysfunctionPost-extubation discomfort (40% regardless of the duration)Hoarsness : edema, injury, disarticulate52% in short-term intubation70% in patients with prolonged intubationSlowing of the reflex swallowing mechanism and risk of aspiration15.8% of patients who were intubated more than 4 days did not have a gag reflexSilent aspiration: Ventilator Associated Pneumonia20% in young population36% in older population

  • Tracheal InjuriesCuff pressure related tracheal mucosa ischemiaCuff pressure tracheal damage: tracheal ulceration, edema and sub-mucosal hemorrhageTracheal dilatation: tracheomalaciaTracheal stenosis:At the site of the cuff (50%)At the site of the tracheostomy (35%)Unclear (15%)

  • Unplanned ExtubationSelf extubation (8%) and accidental extubation (1%)Longer ICU and hospital stayIncreased ICU and hospital mortality

  • THANK YOU*

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