Introduction

In this chapter, endotracheal intubation will refer to trans-laryngeal intubation (that is oral or nasal intubation of the trachea), and tracheal intubation will refer to either endotracheal intubation or intubation via a tracheostomy (Figure 4.1). A supraglottic airway is an airway that does not pass across the vocal cords, such as an oropharyngeal airway or a laryngeal mask.

Intubation of the trachea with a cuffed tube is the only way to simultaneously provide a secure airway, repeated access to the trachea and ventilatory support. Unfortunately, the placement of an artificial airway, be it a supraglottic airway or an endotracheal or tracheostomy tube, will bypass many of the patient's natural defences and thus increase the risk of upper and lower airway colonization, aspiration and infection. To enable the patient to tolerate the airway, the use of sedative, analgesic or muscle relaxants may be required with the resultant risk of cardiovascular, respiratory and neuromuscular complications. Therefore, unless absolutely necessary, it is desirable to avoid the use of artificial airways, for example, by using face mask oxygen or an external airway interface to achieve non-invasive ventilation. Indeed, it has become clear that non-invasive ventilation as opposed to tracheal intubation can, in some circumstances, reduce morbidity and mortality in the critically ill (Chapter 3).