Airway Management Health Article

Definition

Airway management involves ensuring that the patient has a patent airway through which effective ventilation can take place.

Purpose

An obstructed airway means that the body is deprived of oxygen. If ventilation is not reestablished, brain death will occur within minutes. The primary purpose of airway management is to provide a continuously open airway along with a continuous source of oxygen. When a patient is critically ill and requires an artificial airway and mechanical ventilation, it is the responsibility of the healthcare professionals caring for the patient to ensure that the airway is secure.

Another goal of airway management is to provide an artificial airway that is as close to the patient's natural airway as possible. This may mean mechanically performing physiological functions such as humidifying inspired air and removing secretions.

Precautions

Airway management is a necessity for any patient who has an artificial airway. If the patient is restless or agitated, it is recommended that activities such as suctioning or endotracheal tube care be postponed until either the patient is calm or a sedative has been given. This is to avoid inadvertent removal of the airway. However, if the patient's respiratory status is unstable, suctioning or repositioning the endotracheal tube should be done if it will stabilize the patient.

Description

Airway management consists of much more than just keeping the breathing tube in the correct position. The tube must be managed so that it allows optimal ventilation with the fewest complications.

Humidification

Humidification of inspired air normally takes place in the upper respiratory tract. When this area is bypassed by an artificial airway (such as an endotracheal or tracheostomy tube), humidification must be performed out-side the body. If supplemental oxygen is used, it will require humidification to prevent drying and irritation of the respiratory tract and to facilitate removal of secretions. There are humidification devices available that can be attached to oxygen flow meters or ventilators.

Suctioning

Suctioning consists of inserting a sterile catheter into the endotracheal or tracheostomy tube in order to remove secretions. This is an extremely important part of caring for a patient with an artificial airway, since the reflex of coughing, which would normally remove these secretions, is not effective. The patient will experience respiratory distress if the tube is obstructed by sputum. Suctioning should be performed only when the patient

needs it; however, the need should be assessed at least every two hours.

A number of studies have been done to find ways to minimize the complications of suctioning. Equipment should be sterilized to decrease the risk of infection. There are now closed suction systems available that are attached to the ventilator tubing on one end and to the artificial airway on the other. The catheter remains protected inside a sterile plastic sleeve that is changed every 24 hours. This system limits the amount of times the tubing must be disconnected from the airway, thus reducing exposure of the trachea to environmental contaminants.

Suctioning causes oxygen deprivation for the time that the suction is applied. Hypoxemia can be minimized by preoxygenating the patient with 100% oxygen prior to suctioning and between each pass of the suction catheter. (This can be done by either pushing the 100% oxygen button on the ventilator or by using a bag-valve-mask device.) The patient's pulse oximetry should be monitored while suctioning. The duration of each suction pass should be limited to 10 seconds and the number of passes should be limited to three or less if possible. This decreases hypoxemia and airway trauma. Studies have shown that using intermittent suction is no more beneficial than continuous suction.

Installation of a small amount of saline prior to suctioning was a common procedure in the past. It was thought that saline helped to loosen secretions and to facilitate their removal, but studies have shown this is not the case. On the contrary, saline installation has been shown to increase infection rates and to cause decreased oxygen levels for longer periods than suctioning without saline use. This procedure is no longer regarded as beneficial.