Adverse effects of Endotracheal Intubation

OVERVIEW

• Can be classified anatomically or into immediate, short and long term complications.
• Below is anatomically.

AIRWAY

• Dental Trauma
• Failure to Intubate

• careful assessment of risk factors (history, examination, previous intubations)
• optimal positioning
• having a back up plan to provide oxygenation (bagging, LMA, guedels, nasopharyngeal airways, trans-tracheal airways)

• Failure to Ventilate or Oxygenate (see above)
• Damage to airway (cord injury, false passage creation)

• multiple laryngoscopies
• intubation for a prolonged length of time
• limit laryngoscopies
• have a back up plan
• gentle manipulation with airway devices

• Oesophageal intubation

• ETCO2 use

• Subglottic stenosis

• assessment for early extubation
• vigilant cuff pressure measurement
• early tracheostomy

• Tracheo-oesophageal Fistula (see subglottic stenosis above)

RESPIRATORY

• Endobronchial intubation

• careful attention on insertion
• clinical assessment after intubation
• CXR

• Aspiration

• aspiration of N/G tubes
• starve if able
• prokinetics
• rapid sequence induction

• Bronchospasm

• if occurs can treat with: salbutamol, adrenaline, ketamine, Mg

• Hypoxia from de-recruitment of lungs

• conversion from spontaneous ventilation -> positive pressure ventilation results in de-recruitment when patient apnoeic
• preoxygenation
• quick securement of airway
• increasing PEEP on ventilator

• Sputum retention + pneumonia

• head up
• suction
• chest physio
• early antibiotics

• Barotrauma

• protective lung ventilation

CARDIOVASCULAR

• Hypotension (cardiovascular collapse)

• multi-factorial: drug induced, patient often have high sympathetic tone which is obtunded with induction of anaesthesia
• use of balanced, haemodynamically stable agents for induction
• judicious use of vasoactive medications
• assess for tension pneumothorax and decompress if indicated

• Hypetension and Myocardial Ischaemia

• from laryngoscopy and tracheal stimulation
• balanced anaesthetic on induction

NEUROLOGICAL

• Increased ICP

• obtund haemodynamic response to laryngoscopy with hypnotic and fasting acting opioid

• Potential spinal cord injury on laryngoscopy in patient with an unstable cervical spine

• inline immobilisation
• awake fiberoptic intubation

• Requirement for sedation and analgesia

OTHER

• Adverse drug reactions
• Bacteraemia
• Requirement for close monitoring (one-one nursing care)