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Home | Critical Care Compendium | Adverse effects of Endotracheal Intubation

Adverse effects of Endotracheal Intubation

by Chris Nickson, Last updated August 15, 2012

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)

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About Chris Nickson

An oslerphile emergency physician and intensivist suffering from a bad case of knowledge dipsosis. Key areas of interest include: the ED-ICU interface, toxicology, simulation and the free open-access meducation (FOAM) revolution. @Twitter | + Chris Nickson | RAGE | INTENSIVE| SMACC

Reader Interactions

Comments

  1. paolo formentini says

    September 27, 2017 at 4:17 pm

    Hi Doc. Tnx for your article! I’ve translate into Italian language here http://www.amicidel118.org/?p=626 tell me if I have to correct something, thanks.
    P. Formentini ER Nurse

    Reply

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