Combitube

An Combitube ( Combitube manufacturer names or modify EasyTube ) is a tool to secure the airway. It represents an alternative to endotracheal intubation and is mainly used in emergency situations when the latter fails. In this framework, the application in the policies of various professional societies is provided, such as during resuscitation. In routine clinical practice of anesthesia, however, the Combitube does not matter. It was developed in Vienna in 1987.

Construction

The Combitube is like the endotracheal tube from an open hose at both ends of flexible plastic. However, it contains, in contrast to this two lumens and is provided with two Cuffs (block cuffs to seal ), which can be inflated individually. The upper proximal cuff surrounding the tube approximately in the center, while the lower ( distal ) is mounted at the end. Between the cuff ends, the proximal lumen, below the lower the distal lumen. At this each ventilation devices can be connected at the outer end of the tube.

Operation

The Combitube is inserted blindly into the neutral position of the head. Usually ( about 95 % of cases) the tip is then in the gullet (esophagus ), in less than 5 % of cases in the windpipe ( trachea). The lower cuff is so also in the esophagus or trachea, the upper throat area. After blocking both Cuffs thus allows you, in most cases via the proximal lumen respiration, as the air, sealed up and down through the cuff, can flow into the lungs through the larynx. In cases in which the tube is located directly in the trachea, can be ventilated through the distal lumen, location and function then correspond to an endotracheal tube. The appropriate lumen must be identified clinically ( breath sounds over the lungs) and technical ( capnography, special oesophageal detector device).

Structure and function of the Combitube resemble the laryngeal tube. Again, this is inserted blindly, but is almost always to be in the esophagus due to its construction. He therefore has only a lumen that terminates between the two cuffs.

Risks

The use of the Combitube is demanding. Through too deep insertion of both openings come in the esophagus to lie and ventilation is impossible. In addition, frequently occurs also confusion between the adapter.

Even when correctly position complications can occur. The most common problem is an aspiration of gastric contents with the following pneumonia, since the sealing by the cuff in the esophagus is often insufficient. Violations of the oral cavity, larynx or esophagus are possible, which may lead to a pneumothorax and subcutaneous emphysema.

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