Types and characteristics of endotracheal intubation

Tracheal intubation is the core technology for establishing an artificial airway and ensuring ventilation. Various types have been developed according to clinical needs. The following is a systematic classification based on the four dimensions of intubation route, lumen structure, material structure and special functions, and summarizes their respective characteristics:

I Classification by intubation route
1. Oral endotracheal intubation
- Features: The fastest operation, suitable for emergency treatment; the inner diameter of the catheter is large (convenient for suction and bronchoscopy); avoid nasal damage.
- Limitations: difficult to fix and easy to shift; difficult to care for the oral cavity; poor tolerance of awake patients, may damage the glottis.
- Applicable scenarios: cardiopulmonary resuscitation, general anesthesia surgery, short-term mechanical ventilation (≤1-2 weeks).

2. Nasotracheal intubation
- Features: thinner tube, weak foreign body sensation and good tolerance; stable fixation, convenient for oral care.
- Limitations: complicated operation, easy to cause nose bleeding and sinusitis; difficult to aspirate secretions; contraindicated for patients with nasopharyngeal hemangioma.
- Applicable scenarios: patients who need long-term intubation (such as ICU), maxillofacial surgery or limited mouth opening.

3. Intubation via tracheostomy
- Features: Traumatic operation, tube placement through tracheotomy; optimal fixation, few complications with long-term use.
- Limitations: High surgical risk (bleeding, infection); long recovery period.
- Applicable scenarios: patients with long-term mechanical ventilation (>2 weeks), laryngeal lesions or head and neck surgery.

II Classification by lumen structure
1. Single-lumen endotracheal tube
- Features: single-balloon design, simple structure; suitable for conventional ventilation and anesthesia.
- Limitations: unable to separate the two lungs, not suitable for thoracic surgery.
- Subtypes:
- Ordinary type: PVC material, economical and applicable.
- Reinforced type: built-in spiral steel wire, anti-compression and anti-bending, suitable for neck flexion surgery.

2. Double-lumen endobronchial tube (DLT)
- Features: Double-lumen double-balloon design, achieving single-lung ventilation and lung isolation; divided into left-sided tube (LDLT) and right-sided tube (RDLT).
- Limitations: Complex operation, requiring fiberoptic bronchoscope positioning; right-sided tube is prone to insufficient ventilation of the right upper lobe due to anatomical variation.
- Innovative design:
- Visual RDLT: Built-in camera monitors the position of the side hole to reduce the risk of displacement.
- Wall-less RDLT: Eliminate the bronchial wall to avoid blocking the right upper lobe opening.

III Classification by material and structure
1. Rigid PVC cannula
- Features: low cost, high strength, suitable for long-term mechanical ventilation.
- Risks: strong mucosal irritation, possible tissue damage.

2. Silicone soft cannula
- Features: soft and smooth, low mucosal irritation; suitable for children or sensitive patients.
- Limitations: easy to fold and deform, requiring reinforced design support.

3. Cuff type
- Uncuffed tube: for children (to avoid airway stenosis).
- High volume and low pressure cuff: mainstream for adults, good sealing and reduced ischemic damage.

IV. Special function intubation
1. Fiberoptic bronchoscope guided intubation
- Features: Insertion under direct vision, high success rate; used for difficult airway (such as cervical fracture, limited mouth opening).
- Limitations: Depends on equipment and operator experience.

2. Anti-laser intubation
- Features: Metal coating or refractory material to prevent airway burning during laser surgery.

3. Pre-shaped intubation (such as RAE tube)
- Features: Pre-bent to avoid intraoperative tube twisting; suitable for head and neck surgery.

V. Precautions for clinical application
- Contraindications: Laryngeal edema, pharyngeal abscess, and cervical fracture are relative contraindications for oral/nasal intubation; giant aortic aneurysm is contraindicated.
- Complications: mucosal injury, esophageal intubation, arrhythmia, ventilator-associated pneumonia (VAP).
- Innovation trends:
●Visualization technology improves positioning accuracy;
●Material improvements (such as DEHP-free silicone) reduce toxicity risks.

Clinical selection needs to comprehensively consider the urgency of the disease, the type of surgery, the expected intubation time, and the patient's anatomical characteristics, and balance safety and operational efficiency. For complex thoracic surgeries, the continuous improvement of RDLT (such as side hole optimization) is gradually solving the problem of lung isolation.