INDICATION
To maintain the patency of the airway.
Failure of ventilation or oxygenation.
Patients anticipated clinical course and likelihood of deterioration.
1.PATENCY OF THE AIRWAY
It is essential to maintain the patency of the airway for adequate oxygenation and ventilation.
If the patient is unable to maintain the airway the patency is established by chin lift, jaw thrust , oral or nasal airways.
The patency of the airway is assess by the ability of the patient to phonate, level of consciousness , ability to manage the secretions.
Traditionally the patients where assessed for gag reflex but 12 to 25% of the individuals it may be absent. There is also no evidence to show that its presence or absence will affect the protective reflex or the need for intubation.
2.FAILURE OF VENTILATION OR OXYGENATION
Failure of ventilation which is not reversible by clinical means or increasing hypoxemia inspite of supplemental oxygen is a primary indication for intubation. This assessment is clinical and depends on the pulse oximetery and changes in the ventilation pattern.
ABG is not used as an indicator .
3.ANTICIPATED CLINICAL COURSE
Certain clinical condition may indicate intubation despite of having adequate ventilation , oxygenation or patency of the airway at the time of assessment depending on the anticipation of deterioration that would require airway intervention.
Eg: in a multiple trauma with or without head injury, TCA poisoning.
EMmedonline
