intratracheal

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endotracheal

 [en″do-tra´ke-al]
within the trachea.
endotracheal tube an airway catheter inserted in the trachea during endotracheal intubation to assure patency of the upper airway by allowing for removal of secretions and maintenance of an adequate air passage. Endotracheal intubation may be accomplished through the mouth using an orotracheal tube, or through the nose using a nasotracheal tube. Numerous different endotracheal tubes are available. Tubes for adults are almost always “cuffed” to prevent air and aspiration leakage and allow for their use with a mechanical ventilator. (Pediatric tubes are not cuffed, since the airway is narrower at the distal end.) The cuff is a balloonlike device that fits over the lower end of the tube and is attached to a narrow tube that extends outside the body and allows for inflation of the cuff. Once the cuff is inflated there is no flow of air through the trachea other than that going through the endotracheal tube. Care should be taken not to overinflate the cuff.

Passage of an endotracheal tube during surgery is a well-established and long-used technique. In recent years the procedure has become a part of medical management of ventilatory failure as an alternative to tracheotomy. Tube placement is verified by watching the tube pass through the vocal cords, listening to the lungs and stomach, and checking it radiographically within one hour of placement. Adjunct techniques such as capnometry and pulse oximetry can also be used to verify placement. Endotracheal intubation has the advantages of not requiring a surgical procedure as does tracheotomy, of removal of the tube (extubation) being less involved, and of the procedure being able to be repeated as necessary.

The endotracheal tube cannot be used for long-term relief of ventilatory failure. A tracheostomy is required for long-term ventilator-dependent patients.

Complications of endotracheal intubation include damage to the vocal cords, erosion, and eventual stricture of the larynx. Pulmonary infections may result from interference with the normal protective mechanisms of the glottis and from the introduction of pathogenic organisms into the respiratory tract and difficulty in their removal by coughing.
Patient Care. The respiratory apparatus for assisted ventilation must be stabilized. Secure anchoring of the tube and apparatus is necessary to prevent tension on or misplacement of the tube. Its position is checked periodically by auscultation, chest x-ray, or capnography.

The inhaled air must be adequately humidified; the normal humidifying function of the upper respiratory tract is not present because the tube bypasses that area. Inhaled air must also be protected from contamination as much as possible. suctioning of secretions via the tube is done with gentleness and according to the basic guidelines established for this procedure. The patient will require mouth care and frequent observation for signs of pressure against the lips and nose. An emergency tracheotomy tray and an extra endotracheal tube are kept at the bedside. Since a patient with an endotracheal tube in place cannot talk, means must be arranged to assist with communication. During an emergency, medications that can be administered through the endotracheal tube include epinephrine, atropine, and lidocaine.
Suctioning an endotracheal tube. From Lammon et al., 1995.

intratracheal

/in·tra·tra·che·al/ (-tra´ke-al) endotracheal.

in·tra·tra·che·al

(in'tră-trā'kē-ăl)
Method of giving medications through the trachea.

intratracheal

Within the TRACHEA.

intratracheal

endotracheal.

intratracheal therapy
through an endotracheal tube or by percutaneous injection into the trachea for the delivery of antibiotics into the lungs.