Endotracheal intubation is the definitive way to secure an airway
in a patient with respiratory insufficiency, cardiopulmonary insufficiency,
or neurological compromise. This chapter will discuss oral and nasal
- ▪ Airway: Conduit through which gas passes between the
atmosphere and the lungs, including the oropharynx, nasopharynx,
hypopharynx, trachea, or an artificial airway such as an endotracheal tube
- ▪ ETT: An artificial airway usually inserted through the
mouth or nose into the trachea (Figure 27-1). While a variety of
variants are available for specialty uses, the typical ETT has the
- —Made of flexible, clear plastic material.
- —Equipped with a standard-sized (universal) 15 mm
connector at the proximal end, which ensures compatibility with
all ventilator circuits and ventilation bags (Figure 27-2).
- —Having an opaque stripe along the length of the
tubing to facilitate tube location on chest x-ray.
- —Beveled tip to facilitate passage through vocal
- —Length markers to assist in correct placement of
- —ETTs may or may not be equipped with an inflatable
cuff just proximal to the distal tip of the tube which can be inflated
to sequester the trachea from the hypopharynx—pediatric
ETTs are typically uncuffed to maximize the available diameter of
the tube for gas passage, whereas adult tubes are typically cuffed.
- —Cuffed ETTs are often equipped with a “Murphy
eye,” which is a side vent just proximal to the distal
end of the tube, designed to allow an alternative air passage in
the event that the distal tip was occluded by contact with the tracheal
wall or a plug (Figure 27-3).
- ▪ Laryngoscope (Figure 27-4): One of a variety of tools
designed to allow an operator to open and align the oral pharynx
and hypopharynx, and illuminate the vocal cords, thereby permitting
insertion of an oral ETT under direct visualization.
- ▪ Direct laryngoscopy: The act of using a laryngoscope to
visualize the airway—as compared with indirect laryngoscopy
using either a mirror or fiberoptic laryngoscopy. The latter procedures
are typically performed for diagnostic reasons.
- ▪ Oral entotracheal intubation: Placement of the distal tip
of an ETT in the trachea, typically using direct laryngoscopy, although
the procedure can be performed using a fiberoptic bronchoscope to locate
the airway and subsequently threading the ETT over the bronchoscope
into the trachea.
- ▪ Nasal endotracheal intubation: Placement of the distal
tip of an ETT into the trachea after passage of the ETT through
the nose, nasopharynx and hypopharynx. The ETT can be passed blindly using
breath sounds as a locator or alternatively threaded over a bronchoscope.
A standard ETT with a syringe attached to the “pilot
balloon” for cuff inflation, as well as a malleable stylet
to form the tube during insertion and an end-tidal C2 detector.