Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- 8 Managing the airway
- 9 Tracheostomy
- 10 Venous access
- 11 Invasive haemodynamic monitoring
- 12 Pulmonary artery catheter
- 13 Minimally invasive methods of cardiac output and haemodynamic monitoring
- 14 Echocardiography and ultrasound
- 15 Central nervous system monitoring
- 16 Point of care testing
- 17 Importance of pharmacokinetics
- 18 Radiology
- SECTION 3 System Management in Cardiothoracic Critical Care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
8 - Managing the airway
from SECTION 2 - General Considerations in Cardiothoracic Critical Care
Published online by Cambridge University Press: 05 July 2014
- Frontmatter
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- SECTION 1 Admission to Critical Care
- SECTION 2 General Considerations in Cardiothoracic Critical Care
- 8 Managing the airway
- 9 Tracheostomy
- 10 Venous access
- 11 Invasive haemodynamic monitoring
- 12 Pulmonary artery catheter
- 13 Minimally invasive methods of cardiac output and haemodynamic monitoring
- 14 Echocardiography and ultrasound
- 15 Central nervous system monitoring
- 16 Point of care testing
- 17 Importance of pharmacokinetics
- 18 Radiology
- SECTION 3 System Management in Cardiothoracic Critical Care
- SECTION 4 Procedure-Specific Care in Cardiothoracic Critical Care
- SECTION 5 Discharge and Follow-up From Cardiothoracic Critical Care
- SECTION 6 Structure and Organisation in Cardiothoracic Critical Care
- SECTION 7 Ethics, Legal Issues and Research in Cardiothoracic Critical Care
- Appendix Works Cited
- Index
Summary
Introduction
The provision of a patent airway from the external atmosphere to the lower trachea is commonly required to facilitate mechanical ventilation in the critically ill. A cuffed tracheal tube provides the highest degree of airway maintenance and protection and this is the most frequently used device.
Core competencies for airway management in cardiothoracic critical care include relevant physiology and pharmacology, care of the intubated patient, strategies for intubation and extubation, intubation of a patient at risk of aspiration, the management of failed intubation and failed ventilation and specialized techniques for lung isolation.
Physiology
In normal adults breathing air, alveolar minute ventilation is approximately 3.5 L/min. The Pao2 for a given inspired oxygen concentration can be calculated from the alveolar gas equation.
A decrease in alveolar minute ventilation will cause a reduction in Pao2 and elevation in Paco2. Hypoxaemia secondary only to a reduction in minute ventilation can be treated easily by increasing the inspired oxygen.
The relationship between Pao2 and Paco2 is more complex and is influenced by venous admixture and cardiac output. With a venous admixture or shunt fraction greater than 20% to 25%, it may prove impossible to raise the Pao2 to normal, even with 100% inspired oxygen.
- Type
- Chapter
- Information
- Core Topics in Cardiothoracic Critical Care , pp. 55 - 64Publisher: Cambridge University PressPrint publication year: 2008