CHAPTER
mm
Tracheal intubation
TUBE SIZE
OBJECTIVE
Use the largest suitable tracheal tube - a snug
This chapter discusses the practicalities of intubation. However, it is not
fit is important. Too small a tube will not allow you to inflate the lungs especially if they are
possible to learn how to intubate
stiff or full of fluid (as at birth). If the tube is too
from a book, a lecture, a manikin or a
small gas will escape through the gap between the tube and the tracheal wall and, if the lungs are at all stiff, so much gas will escape through the leak that they will not be inflated sufficiently. This can easily be detected by listening at the mouth or over the neck with a stethoscope while inflating the lung. Bubbles may appear at the mouth and chest movement will be poor. If you have chosen the right size tube and you can hear a large air leak you have intubated the oesophagus.
video. The best way is to be taught on an anaesthetised patient by an experienced practitioner.
SDLATracheal intubation has been seen as the gold standard in airway management. What are the advantages and disadvantages of tracheal intubation in newborn resuscitation?
Tracheal tubes are classified by their internal diameter (ID) in millimetres. If a parallel sided
WHY INTUBATE
Most babies who are apnoeic at birth respond to
tracheal tube is used then most term babies will
simple facemask resuscitation.",71 Intubation may be essential, however, if the larynx or trachea is
need a 3.5mm ID tube though a very large baby
blocked with inhaled material. Intubation also
may need a 4.0 mm tube. Babies under about 1000 gm will need a 2.5 mm tube and those
provides a secure airway leaving the single
between about 1000 and 1800 gm may suit a
handed operator free to concentrate on other
3.0 mm tube. However, different makes of tube
things and in preterm babies it allows you to give
have different wall thicknesses and though it is the internal diameter that is most important from the respiratory point of view it is the
artificial surfactant. Intubation, with the correct size tube, can also make the ventilation of abnormally stiff lungs easier. Surfactant deficient lungs, or 'dry' lungs following prolonged rupture
outside diameter that determines whether the
of membranes (days or weeks) can occasionally
tube will fit snugly into the larynx of any particular baby. Some labour wards still use
be particularly difficult to aerate unless sustained pressures of 30 or even 35 cm of water are used
shouldered Cole's tubes. The shoulder of the
at first.170'1591
Cole's tube makes a good seal at the larynx and a 3.0mm ID tube is appropriate for most babies over 2000 gm and a 2.5mm ID tube for most
IT SHOULD BE POSSIBLE TO PLACE A TRACHEAL TUBE WITHIN 30 SECONDS
IF YOU FAIL TO DO SO, REVERT TO MASK INFLATION BEFORE TRYING AGAIN
smaller babies.
Skill in responding to any emergency demanding intubation depends on the prior acquisition of good technique. Develop a standard, planned and structured approach
from the start. Many have found the approach described on p 34 useful.
When intubation is necessary it can be assumed that the baby is already limp, unresponsive and unconscious. Intubation in such circumstances is
not difficult, although it is not a skill that staff should be expected to display without prior supervised experience.1'2, H '5i m|
NEWBORN LIFE SUPPORT
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