Endotracheal Tube(Archived)

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 endotracheal tubes, further research is necessary to optimize their use. For example, ventilator-associated pneumonia (VAP) is a significant concern, and the ETT itself is felt to be a primary agent for the development of VAP.

Pediatric ETTs are sized by age, with options across the spectrum from premature infants to adult-size teenage children. Historically, pediatric endotracheal tubes were uncuffed due to concerns that the pressure from the cuff could damage the trachea through pressure necrosis, as the airway just below the vocal cords (at the cricoid cartilage) is the narrowest 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 ETTs. Several well-established criteria are available to aid in selecting the ETT size.