critical care medicine
Tracheal Intubation
Complications of Tracheal Intubation
Complications include Direct trauma Esophageal intubation Tracheal erosion or stenosis Laryngoscopy can damage lips, teeth, tongue, and supraglottic and subglottic areas. Tube placement in the esophagus, if unrecognized, causes failure to ventilate and potentially death or hypoxic injury. Insufflating a tube in the esophagus causes regurgitation, which can result in aspiration, compromise subsequent bag-valve-mask ventilation, and obscure visualization in subsequent intubation attempts. Any translaryngeal tube injures the vocal cords somewhat; sometimes ulceration, ischemia, and prolonged cord paralysis occur. Subglottic stenosis can occur later (usually 3 to 4 weeks). Erosion of the trachea is uncommon. It results more commonly from excessively high cuff pressure. Rarely, hemorrhage from major vessels (eg, innominate artery), fistulas (especially tracheoesophageal), and tracheal stenosis occur. Using high-volume, low-pressure cuffs with tubes of appropriate size and measuring cuff pressure frequently (every 8 hours) to maintain it at<30 cm water decrease the risk of ischemic pressure necrosis, but patients in shock, with low cardiac output, or with sepsis remain especially vulnerable. 