
Contents
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Airway: Intubation Airway: Intubation
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Indications Indications
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Endotracheal tube selection Endotracheal tube selection
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Cuffed vs. uncuffed tubes Cuffed vs. uncuffed tubes
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Special situations Special situations
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Route of intubation Route of intubation
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ETT fixation ETT fixation
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Complications of intubation Complications of intubation
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Rapid sequence induction (RSI) Rapid sequence induction (RSI)
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Preparation Preparation
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Choice of drugs—induction agents Choice of drugs—induction agents
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Choice of drugs—muscle relaxants Choice of drugs—muscle relaxants
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Technique of RSI Technique of RSI
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Airway: Difficult intubation Airway: Difficult intubation
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Some syndromes associated with difficult intubation Some syndromes associated with difficult intubation
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Other situations where intubation may be difficult Other situations where intubation may be difficult
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Airway assessment Airway assessment
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Techniques Techniques
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ETT position confirmation ETT position confirmation
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Airway: Failed intubation drill Airway: Failed intubation drill
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Airway: Cricothyroidotomy Airway: Cricothyroidotomy
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Indications Indications
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Methods Methods
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Needle cricothyroidotomy (Boxes and ) Needle cricothyroidotomy (Boxes and )
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Sugical cricothyroidotomy (Boxes and ) Sugical cricothyroidotomy (Boxes and )
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Complications Complications
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Reasons for failure of technique Reasons for failure of technique
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Caveats Caveats
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Airway: Tracheostomy Airway: Tracheostomy
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Indications Indications
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Care of the new tracheostomy Care of the new tracheostomy
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Blocked tracheostomy Blocked tracheostomy
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Displaced tracheostomy Displaced tracheostomy
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Changing the tracheostomy tube Changing the tracheostomy tube
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Types of tracheostomy tube Types of tracheostomy tube
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Ventilation via tracheostomy Ventilation via tracheostomy
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Long-term issues Long-term issues
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Breathing/ventilation: Oxygen therapy Breathing/ventilation: Oxygen therapy
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Principles Principles
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Factors determining PaO2 Factors determining PaO2
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Inspired oxygen concentration Inspired oxygen concentration
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Indications for oxygen therapy Indications for oxygen therapy
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Contraindications Contraindications
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Cautions Cautions
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Methods Methods
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Fixed performance device Fixed performance device
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Variable performance device Variable performance device
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Monitoring a patient receiving oxygen therapy Monitoring a patient receiving oxygen therapy
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Weaning Weaning
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Breathing/ventilation: Mechanical ventilation and oxygen support systems Breathing/ventilation: Mechanical ventilation and oxygen support systems
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Physiology Physiology
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Criteria for considering mechanical ventilation Criteria for considering mechanical ventilation
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Clinical situations associated with mechanical ventilation Clinical situations associated with mechanical ventilation
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Respiratory Respiratory
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Cardiovascular Cardiovascular
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Neurological Neurological
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Therapeutic Therapeutic
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Other Other
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Breathing/ventilation: Ventilator modes Breathing/ventilation: Ventilator modes
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Intermittent positive-pressure ventilation (IPPV) Intermittent positive-pressure ventilation (IPPV)
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Positive-end expiratory pressure (PEEP) Positive-end expiratory pressure (PEEP)
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Control modes Control modes
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Volume control (VC) ventilation Volume control (VC) ventilation
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Pressure control (PC) ventilation Pressure control (PC) ventilation
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Pressure-regulated volume control Pressure-regulated volume control
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Support modes Support modes
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Triggering (Box ) Triggering (Box )
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SIMV SIMV
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Pressure support ventilation Pressure support ventilation
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Volume support ventilation Volume support ventilation
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Proportional assist ventilation Proportional assist ventilation
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Airway pressure release ventilation (APRV) Airway pressure release ventilation (APRV)
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Bilevel positive airway pressure (BIPAP) Bilevel positive airway pressure (BIPAP)
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CPAP CPAP
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Principles of ventilation Principles of ventilation
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Initial settings (Table ) Initial settings (Table )
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Breathing/ventilation: Monitoring of a ventilated patient Breathing/ventilation: Monitoring of a ventilated patient
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Breathing/ventilation: Troubleshooting Breathing/ventilation: Troubleshooting
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Low PaO2 Low PaO2
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High PaCO2 High PaCO2
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High airway pressures High airway pressures
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High peak/plateau pressure gap High peak/plateau pressure gap
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Difficulty triggering ventilator Difficulty triggering ventilator
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Breathing/ventilation: Special situations Breathing/ventilation: Special situations
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Acute lung injury/ARDS Acute lung injury/ARDS
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Diaphragmatic hernia Diaphragmatic hernia
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Asthma Asthma
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PPHN PPHN
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Cavopulmonary shunt/Fontan Cavopulmonary shunt/Fontan
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Permissive hypercapnia Permissive hypercapnia
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Breathing/ventilation: Complications Breathing/ventilation: Complications
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Breathing/ventilation: Weaning and predictors of extubation Breathing/ventilation: Weaning and predictors of extubation
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Weaning Weaning
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Principles Principles
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Predictors Predictors
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Failure to wean Failure to wean
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Extubation Extubation
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Criteria Criteria
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Failure Failure
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Management post-extubation Management post-extubation
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Post-extubation complications Post-extubation complications
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Stridor Stridor
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Breathing/ventilation: High-frequency ventilation Breathing/ventilation: High-frequency ventilation
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Breathing/ventilation: Non-invasive ventilation (NIV) Breathing/ventilation: Non-invasive ventilation (NIV)
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CPAP CPAP
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BIPAP BIPAP
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Indications for NIV Indications for NIV
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Rationale Rationale
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Types Types
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Positive pressure approaches Positive pressure approaches
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Negative pressure approaches Negative pressure approaches
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Methods Methods
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Settings Settings
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Reasons for failure Reasons for failure
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Complications Complications
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Monitoring Monitoring
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Predictors Predictors
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Breathing/ventilation: Surfactant Breathing/ventilation: Surfactant
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Types of surfactant Types of surfactant
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Therapeutic uses of surfactant Therapeutic uses of surfactant
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Complications of surfactant administration Complications of surfactant administration
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Genetic disorders of surfactant Genetic disorders of surfactant
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Therapies: Inhaled medications Therapies: Inhaled medications
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Methods of administration Methods of administration
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Aerosol Aerosol
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Nebulization Nebulization
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Vapour Vapour
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Gas Gas
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Drugs Drugs
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Bronchodilators Bronchodilators
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Mucolytics Mucolytics
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Antibiotics/antivirals Antibiotics/antivirals
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Miscellaneous Miscellaneous
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Indications Indications
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Inhaled drug doses/concentrations Inhaled drug doses/concentrations
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Therapies: Nitric oxide delivery Therapies: Nitric oxide delivery
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Therapies: Hyperbaric oxygen therapy Therapies: Hyperbaric oxygen therapy
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Indications for HBOT Indications for HBOT
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Risks of HBOT Risks of HBOT
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Carbon monoxide poisoning Carbon monoxide poisoning
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Therapies: Chest physiotherapy Therapies: Chest physiotherapy
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Principles Principles
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Indications Indications
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Techniques Techniques
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Contraindications/cautions Contraindications/cautions
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Side effects/complications Side effects/complications
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Therapies: Suctioning Therapies: Suctioning
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Procedure Procedure
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Complications Complications
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Therapies: Fibreoptic bronchoscopy Therapies: Fibreoptic bronchoscopy
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Indications Indications
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Contraindications/cautions Contraindications/cautions
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Equipment Equipment
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FFS sizes FFS sizes
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Methods Methods
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Complications Complications
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Therapies: Bronchoalveolar lavage Therapies: Bronchoalveolar lavage
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Principles Principles
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Indications Indications
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Diagnostic Diagnostic
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Therapeutic Therapeutic
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Samples Samples
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Microbiology Microbiology
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Virology Virology
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Histology Histology
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Complications Complications
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Further reading Further reading
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Cite
Extract
...
Airway: Intubation
Indications
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Endotracheal tube selection
Cuffed vs. uncuffed tubes
In infants and younger children, the cricoid ring is the narrowest part of the upper airway and an uncuffed ETT is commonly used. In older children and adults a cuffed ETT is required. The appropriate internal diameter (ID) and length of ETT can be estimated using formulae:
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Special situations
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Route of intubation
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ETT fixation
It is vital that the ETT is securely fixed to the patient's face. Accidental extubation can rapidly lead to life-threatening hypoxia. There are many methods used to secure ETTs, reflecting the fact that no one technique is ideal. A simple method is to use cloth tape secured around the tube and across the face between the top lip and nose (Fig. 8.1).
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Complications of intubation
Immediate complications of intubation include trauma to mouth, teeth and larynx, malpositiion of the ETT (oesophageal or endobronchial intubation) and haemodynamic instability as a result of sedative drugs and initiation of positive pressure ventilation. Late complications include ventilator associated pneumonia, trauma to the subglottic region leading to subglottic oedema or stenosis and pressure effects causing trauma to the nose or mouth. Some of these can be minimized by the use of appropriate monitoring, correct choice of ETT size and reliable tube fixation.
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