critical care medicine
How To Insert an Esophageal Tracheal Double Lumen Tube (Combitube) or a King Laryngeal Tube
Introduction
The esophageal-tracheal double lumen tube (Combitube) and the King laryngeal tube are supraglottic airway devices (also called retroglottic airway devices). (See also Tracheal Intubation , The esophageal-tracheal double lumen tube (Combitube) and the King laryngeal tube are twin-lumen tubes that have fundamental similarities: A large proximal balloon cuff seals the hypopharynx A ventilating, proximal lumen terminates at side ports overlying the laryngeal inlet A distal lumen and its smaller balloon cuff terminate in and seal the upper esophagus (in > 90% of insertions) Supraglottic airways are useful for providing rescue ventilation to unconscious patients or patients without a gag reflex and are also used in some elective settings. The esophageal-tracheal double lumen tube and King laryngeal tube have some advantages over other methods of ventilation: Unlike endotracheal tubes, they can be successfully inserted blindly and by operators with only basic training. Unlike Bag-Valve-Mask Devices , they avoid the difficulties of attaining and maintaining an adequate face-mask seal. They cause less gastric insufflation or aspiration than BVM or Laryngeal Mask Airways (LMA) because they better isolate the esophagus from the trachea and because the distal lumen permits gastric tube insertion Like the other supraglottic airways, the Combitube and King laryngeal tube are temporary airways that must be removed or replaced by a definitive airway, such as an endotracheal tube or surgical airway ( Cricothyrotomy or 