Download Adverse effects of Endotracheal Intubation

Adverse effects of Endotracheal Intubation
13/9/10
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
Jeremy Fernando (2011)
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 derecruitment 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
Jeremy Fernando (2011)
Requirement for sedation and analgesia
OTHER
Adverse drug reactions
Bacteraemia
Requirement for close monitoring (one-one nursing care)
Jeremy Fernando (2011)