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