“Airway management” implies the provision of assistance to a patient in maintaining a patent airway. This chapter will review airway anatomy and basic airway management techniques.
The nose is lined with vessel-rich mucosa designed to warm and humidify the air. Bypassing the nose causes dry gases to reach the respiratory tract and necessitates warming and humidification of gases during mechanical ventilation.
The two nares are divided by a nasal septum that is often not midline. In each naris are three turbinates (Fig. 38-1) that help to condition the inspired gases. Underneath each turbinate lies the opening of perinasal sinus. When these openings are occluded by nasogastric or nasotracheal tubes, fluid tends to accumulate in the sinuses as reflected by a high incidence of radiographic sinus opacification.1
The nasal turbinates. Note that these are easily traumatized during nasal instrumentation. (Used, with permission, from Pierson DJ, Kacmarek R, eds. Foundations of Respiratory Care. New York, NY: Churchill Livingstone; 1992.)
The floor of the nose leading to the nasopharynx is in the same plane as the nasal orifices. When a tube is introduced into the nose, it should be directed straight back rather than caudad (Fig. 38-2), and advanced carefully to avoid injuring the turbinates.
Insertion of a catheter in the nose. The catheter should be directed in parallel with the floor of the nose. (Used, with permission, from Pierson DJ, Kacmarek R, eds. Foundations of Respiratory Care. New York, NY: Churchill Livingstone; 1992.)
Oral structures relevant to airway management include the lips, teeth, and tongue as each may either impede introduction of airway devices into the pharynx or diminish upper airway patency or both during artificial breathing.
The pharynx is shaped like a cone (Fig. 38-3) and includes the nasopharynx and the oropharynx, which join to form the hypopharynx. The walls of the pharynx are typically soft and compliant, but may become stiff, increase in volume, or both when inflamed from any cause.
Lateral (A) and posterior oblique (B) views of the pharynx and larynx, including the laryngeal skeleton. (Reproduced, with permission, from Pierson DJ, Kacmarek R, eds. Foundations of Respiratory Care. New York, NY: Churchill Livingstone; 1992.)
The digestive and respiratory tracts share a common lumen in the pharynx. The posterior portion of the pharynx continues to form the esophagus whereas the anterior portion ends in a series of pouches or fossae ...