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Inadequate ventilation, whether due to sedation and neuromuscular paralysis in the operating room, an obstructed or compromised airway, altered mentation, loss of consciousness, or respiratory failure can lead to brain injury or death within minutes. It is, thus, of great importance to know how to evaluate and address a patient who may require ventilatory support.
INDICATIONS FOR ENDOTRACHEAL INTUBATION
Indications for ENDOTRACHEAL INTUBATION in the operating room include:
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the need to deliver positive pressure ventilation
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protection of the respiratory tract from aspiration of gastric contents
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surgical procedures involving the head and neck or in non-supine positions that preclude manual airway support
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almost all situations involving neuromuscular paralysis
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surgical procedures involving the cranium, thorax, or abdomen
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procedures that may involve intracranial hypertension
Some non-operative indications are:
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profound disturbance in consciousness with the inability to protect the airway
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tracheobronchial toilet
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severe pulmonary or multisystem injury associated with respiratory failure, such as sepsis, airway obstruction, hypoxemia, and hypercarbia
Objective measures may also be used to help determine the need for intubation:
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respiratory rate > 35 breaths per minute
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vital capacity < 15 ml/kg in adults and 10 ml/kg in children
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inability to generate a negative inspiratory force of 20 mm Hg
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PaO2 (arterial partial pressure of oxygen) < 70n mm Hg
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A-a gradient (Alveolar-arterial) > 350 mm Hg on 100% oxygen
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PaCO2 (arterial partial pressure of carbon dioxide) > 55 m Hg (except in chronic retainers)
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dead space > 0.6 L
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