Advances in Translaryngeal Tube Technology

Intubation of the trachea with a cuffed tube can be performed by the translaryngeal route (endotracheal tube) or through a tracheal stoma (tracheostomy tube). Tracheal intubation by one of these routes is the only way to simultaneously provide a secure airway, ventilatory support, and convenient access to the trachea. Unfortunately, the presence of an artificial airway bypasses many of the patient's natural defenses and so increases the chances of upper and lower airway colonization, aspiration, and infection [1]. Sedatives, analgesics or muscle relaxants may be required to improve tolerance of the airway; this risks cardiovascular, respiratory and neuromuscular complications. It is, therefore, desirable to avoid the use of artificial airways, for example, by using facemask oxygen or an external airway interface to achieve noninvasive ventilation (NIV). Indeed it has become clear that NIV as opposed to tracheal intubation can reduce morbidity and mortality in the critically ill. When an artificial airway is required it is the responsibility of both the medical devices industry and the clinician to minimize the comphcations consequent to its use. The major complications directly related to the artificial airway in the critically ill are: