What are the artificial airways in the 13th Egan's book of Respiratory Therapy (RT)?

Artificial Airways in Respiratory Therapy

I cannot provide a specific answer about the 13th edition of Egan's Respiratory Therapy textbook, as the evidence provided does not contain content from this specific textbook. However, I can provide comprehensive information about artificial airways based on current clinical guidelines and research evidence.

Types of Artificial Airways

Artificial airways are devices inserted to maintain airway patency and facilitate ventilation/oxygenation, and they fall into several distinct categories based on their anatomical placement and clinical application.

Supraglottic Airways

• Laryngeal mask airway (LMA) is used during bronchoscopic procedures and can be employed during EBUS-TBNA procedures, with studies showing improved oxygen saturation and hemodynamic stability compared to natural airway approaches 1
• LMAs are commonly temporary devices that sit above the vocal cords and do not enter the trachea 2, 3

Translaryngeal Airways

• Endotracheal tubes (ETT) deliver positive pressure ventilation directly into the trachea and are the primary device for invasive mechanical ventilation 1
• ETTs should be minimum size 8.0 for EBUS-TBNA procedures to accommodate the bronchoscope diameter while allowing adequate gas exchange 1
• Placement of ETTs may block ultrasonographic visualization of higher paratracheal lymph nodes (stations 1, 2R, 2L, and 3P), which is an important consideration during diagnostic procedures 1

Infraglottic Airways

• Tracheostomy tubes provide an alternative route for positive pressure ventilation through a surgical or percutaneous opening in the trachea 1
• Over 5,700 surgical tracheostomies and an estimated 5,000-8,000 percutaneous tracheostomies are performed annually in England alone 1
• Tracheostomy tubes can be temporary or permanent depending on clinical indication 1

Permanent Surgical Airways

• Laryngectomy tubes are used following total laryngectomy, creating a permanent alteration where the upper airway is completely disconnected from the trachea 1
• Approximately 570 laryngectomies are performed annually in England, primarily for laryngeal carcinoma 1
• Patients with laryngectomy are "neck breathers" and require fundamentally different emergency management than those with tracheostomies 1

Clinical Indications for Artificial Airways

Primary Indications

• Management of upper airway obstruction 1
• Airway protection in patients with compromised protective reflexes 1
• Facilitation of weaning from mechanical ventilation 1
• Provision of long-term ventilation support 1
• Assistance with respiratory secretion removal 1

Emergency Indications

• Severe tachypnea (respiratory rate >40 breaths/min) 1
• Muscular respiratory failure with accessory muscle use 1
• Altered mental status with inability to protect airway 1
• Severe hypoxemia despite supplemental oxygen 1

Critical Management Considerations

Catheter Sizing and Suctioning

• Suction catheter size should be small enough to avoid total occlusion of the artificial airway, typically 5-6F in newborns 1
• Catheters with multiple side holes on several planes cause less mucosal invagination than single-hole designs 1
• Negative pressure should not exceed 50-80 cm H₂O to prevent mucosal damage 1
• The most critical preventive measure is restricting suction catheter passage to only the distal tip of the artificial airway to protect airway mucosa from injury 1

Cuff Pressure Management

• Appropriate cuff pressure management prevents aspiration and mucosal damage while ensuring adequate ventilation 4
• Automated cuff pressure control devices are becoming more common in clinical practice 4

Humidification and Secretion Management

• Adequate humidification is essential for preventing secretion-related complications 4
• Monitoring airway patency and removing obstructions are potentially life-saving components of airway management 4

Common Complications

Acute Complications

• Inadequate tube positioning 2
• Pulmonary aspiration 2
• Tracheal laceration or perforation 2
• Hemorrhage and loss of airway 1
• Tube blockage or displacement 1

Long-Term Complications

• Post-intubation tracheal stenosis 2
• Tracheomalacia and tracheomegaly 1, 2
• Vocal cord paralysis 2
• Paranasal sinusitis 2
• Cuff overinflation with vascular compression 2
• Problems related to the stoma itself 1

Pediatric-Specific Concerns

• Tracheobronchomalacia occurs in 45% of infants with chronic lung disease of infancy, with bronchomalacia in 34% 1
• Immature airways have higher compliance and are more susceptible to pressure-induced deformation 1
• Tracheomegaly can develop in very preterm neonates (birth weight <1,000g) requiring mechanical ventilation 1

Key Safety Principles

Securing and Monitoring

• Tubes must be adequately secured to prevent dislodgement or migration 4
• A bite block should be considered for transoral artificial airways regardless of sedation depth 1
• Respiratory therapists must be adept with all monitoring devices and understand appropriate application 4

Prevention Strategies

• Compliance with standardized care protocols is vital for reducing complications, though not all management rules are universally standardized 5
• Vigilant preventive measures during institution of artificial airways are essential 6
• Early search for underlying pathology when complications are suspected 6