Endotracheal Tube

Excerpt

The endotracheal tube (ETT) was first reliably used in the early 1900s. In its simplest form, it is a tube constructed of polyvinyl chloride (PVC) that is placed between the vocal cords through the trachea to provide oxygen and inhaled gases to the lungs. It also serves to protect the lungs from contamination, such as gastric contents and blood. The advancement of the endotracheal tube has closely followed advancements in anesthesia and surgery. Modifications have been made to minimize aspiration, isolate a lung, administer medications, and prevent airway fires. Despite advances in the endotracheal tube, more research to optimize its use is necessary. For example, ventilator-associated pneumonia (VAP) is a major concern, and the ETT itself is felt to be a primary agent for the development of VAP.

Pediatric ETT’s are sized by age with options across the spectrum from premature infants to adult-size teenage children. Historically, pediatric endotracheal tubes were uncuffed for fear that the pressure from the cuff would damage the trachea via pressure necrosis, as the airway just below the vocal cords (cricoid cartilage) is the most narrow part in children. In adults, the narrowest portion of the airway is the vocal cords. Except for neonatal patients, this practice has largely been discontinued in favor of cuffed pediatric ETT’s. A few well-established criteria are available to aid in ETT size selection.