Endotracheal Intubation via Direct Laryngoscopy

Abstract

Endotracheal intubation is an important skill for critical care physicians. Adequate preparation is key to a successful intubation. Common indications for intubation are insufficient oxygenation or ventilation, acute respiratory failure, airway protection in depressed mental status, short-term hyperventilation to manage increased intracranial pressure, or to manage copious secretions or bleeding from the airway. Supraglottic or glottis pathology that precludes the placement of a tracheal tube is an absolute contraindication for the endotracheal intubation. There are multiple medications for induction; the purpose is to limit physiological stress responses to endotracheal intubation. Assessment of anatomy can be done using the Modified Mallampati classification. Preparation for intubation includes proper assessment, preoxygenation, having a backup approach to secure the airway, having all instruments and tools ready and available. There are multiple different laryngoscope blades and the intubation technique differs between blades. Confirming placement of endotracheal tube is done using end-tidal carbon dioxide determination or esophageal detection device; supplemented by clinical and radiological findings. The gold standard for confirming endotracheal tube placement is by direct visualization with a bronchoscope.