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  • Print publication year: 2010
  • Online publication date: January 2011

Chapter 10 - Tracheal tubes, tracheostomy tubes

from Section 2 - Clinical


This chapter discusses the fundamental thermodynamic concepts such as laminar flow and turbulent flow. Flow tends to be turbulent in upper airway obstruction, so gas density is influential. The functional anatomy of the upper airway can be reduced to a consideration of a collapsible segment (the pharynx) between two rigid segments (the nasopharynx and the trachea). This system behaves as a Starling resistor and airflow can become limited or completely abolished during spontaneous (negative intrathoracic pressure) breathing. Maintenance of pharyngeal airway patency is a complex neuromuscular phenomenon. In airway obstruction at the pharyngeal level, inspiratory flow may not be increased by increased inspiratory effort, but can be increased by positive pressure applied above the obstruction. The chapter describes the physics and function of a device which permitted ventilation of patients during bronchoscopy. There are a number of misconceptions regarding the operating principles of the Sanders injector.

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Further reading

BolderPM, HealyTE, BolderAR, BeattyPC, KayB. (1986). The extra work of breathing through adult endotracheal tubes. Anesthesia and Analgesia, 65, 853–859.
ChastreJ. (2008). Preventing ventilator-associated pneumonia.: Could silver-coated endotracheal tubes be the answer?Journal of the American Medical Association, 300, 842–844.
CrawleyBE, CrossDE. (1975). Tracheal cuffs: A review and dynamic pressure study. Anaesthesia, 30, 4–11.
HannallahMS, SudyerhoudJP. (1996). Endotracheal tubes and respiratory care. In: BenumofJL (Ed.), Airway Management Principles and Practice. St Louis: Mosby.
JaenssonM, OlowssonLL, NilssonU. (2010). Endotracheal tube size and sore throat following surgery: A randomized study. Acta Anaesthesiologica Scandinavica, 54, 147–153.
KohKF, HareJD, CalderI. (1998). Small tubes revisited. Anaesthesia, 53, 46–50.
KollefMH, AfessaB, AnzuetoA, et al. (2008). Silver-coated endotracheal tubes and incidence of ventilator-associated pneumonia: The NASCENT randomized trial. Journal of the American Medical Association, 300, 805–813.
LoeslerEA, HodgesM, GliedmanJ, StanleyTH, JohansenRK, YonetaniD. (1978). Tracheal pathology following short-term intubation with low- and high-pressure endotracheal tube cuffs. Anesthesia and Analgesia, 57, 577–579.
MitchellV, AdamsT, CalderI. (1999). Choice of cuff inflation media during nitrous oxide anaesthesia. Anaesthesia, 54, 32–36.
PneumatikosI, DragoumanisCK, BourosD. (2009). Ventilator-associated pneumonia or endotracheal tube-associated pneumonia?: An approach to the pathogenesis and preventative strategies emphasizing the importance of endotracheal tube. Anesthesiology, 110, 673–680.
RaiMR, ScottSH, MarfinAG, PopatMT, PanditJJ. (2009). A comparison of a flexometallic tracheal tube with the intubating laryngeal mask tracheal tube for nasotracheal fibreoptic intubation using the two-scope technique. Anaesthesia, 64, 1303–1306.
SeegobinRD, Van HasseltGL. (1986). Aspiration beyond endotracheal cuffs. Canadian Journal of Anaesthesia, 33, 273.
ShapiroM, WilsonRK, CasarG, BloomK, TeagueRB. (1986). Work of breathing through different sized endotracheal tubes. Critical Care Medicine, 14, 1028–1031.
ShroffPP, PatilV. (2009). Efficacy of cuff inflation media to prevent postintubation-related emergence phenomenon: Air, saline and alkalinized lignocaine. European Journal of Anaesthesiology, 26, 458–462.
SuzukiA, TampoA, AbeN, et al. (2008). The Parker Flex-Tip tracheal tube makes endotracheal intubation with the Bullard laryngoscope easier and faster. European Journal of Anaesthesiology, 25, 43–47.
TonnesenAS, VereenAS, ArensJF. (1981). Endotracheal tube cuff residual volume and lateral wall pressure in a model trachea. Anesthesiology, 55, 680–683.
WeissM, DullenkopfA, BöttcherS, et al. (2006). Clinical evaluation of cuff and tube tip position in a newly designed paediatric preformed oral cuffed tracheal tube. British Journal of Anaesthesia, 97, 695–700.
WeissM, DullenkopfA, FischerJE, KellerC, GerberAC. (2009). Prospective randomized controlled multi-centre trial of cuffed or uncuffed endotracheal tubes in small children. British Journal of Anaesthesia, 103, 867–873.

Websites (British Standards)
BS EN ISO 5366–1:2009 Anaesthetic and respiratory equipment. Tracheostomy tubes. Part 1: Tubes and connectors for use in adults
BS EN 1782:1998 tracheal tubes and connectors
BS EN ISO 14408:2005 tracheal tubes designed for laser surgery.
BS EN 1282–2:1997 Anaesthetic and respiratory equipment. Tracheostomy tubes. Paediatric tubes (percutaneous tracheostomy tubes) (tracheostomy tubes) (tracheal and tracheostomy tubes) (Mallinckrodt tubes) (Parker Flex Tip tubes) (cuff pressure monitors) (recurrent laryngeal monitoring tubes)