Specialized Endotracheal Tubes

Recent years have witnessed an explosion in the development of devices for securing the airway. The standards adopted by the American Society for Testing and Materials, which govern the manufacture of all types of endotracheal tubes and airway devices, are described. Endotracheal tube (ET) cuffs are particularly prone to causing serious damage to the trachea and have undergone the most development. Certain situations require the separation of ventilation to each lung for the purpose of surgical exposure, control of infection or bleeding, or simply to match ventilation techniques to dissimilar lung compliance. This technique and these airway devices require particular skills and management techniques to ensure safe application. A large number of ETs have been developed for laser surgery, a situation accompanied by an extreme risk of ignition of the ET and an airway fire. Metallic tubes, water-filled or tandem cuffs, and a variety of fire-resistant wrappings have all been developed to address this concern. Other ETs have been modified to enhance care of the intubated patient. Additions such as ports for suctioning, medication delivery, or distal airway pressure measurements make it possible to tailor patient care. The newest ET development is the intubating laryngeal mask airway, which is a combination cuffed oropharyngeal airway and a blind guided-ET insertion system. Head and neck surgery frequently incorporates the airway within the surgical field. Preformed ET and wire-reinforced ET prevent kinking and redirect ventilator circuits away from the surgical field giving the surgeon unimpeded access.