Combitube
Encyclopedia
The Combitube is a blind insertion airway device (BIAD) often used in the pre-hospital, emergency setting. It is designed to facilitate the tracheal intubation
of a patient in respiratory distress. It consists of a cuffed, double-lumen tube that is inserted into a the patient's airway facilitating ventilation. Inflation of the cuff allows the device to function similarly to an endotracheal tube and usually closes off the esophagus
, allowing ventilation
and preventing pulmonary aspiration
of gastric
contents.
The simplicity of placement is the main advantage of the Combitube over endotracheal intubation. When intubating with a traditional endotracheal tube, care must be taken to visually ensure that the tube has been placed in the trachea while the dual-lumen design of the Combitube allows for ventilation to proceed regardless of esophageal or tracheal placement. Generally, the tube enters the esophagus and ventilation is provided through tube number one. In the rare instance where the Combitube intubates the trachea, ventilation is provided through tube number two while tube one is clamped. A device called the Positube, which is a esophageal intubation detection device, can be used on tube number two to rule out the intubation of the Combitube in the trachea. The Positube checks for air flow resistance on tube number two and is very helpful in checking proper Combitube placement when intubation is performed in noisy environment's.
The Combitube's ease of use makes it ideal for use in the pre-hospital, emergency setting where advanced level providers capable of placing an endotracheal tube are often not immediately available. The drawbacks of Combitube use center around an inability to perform deep (subglottic) suctioning assuming esophageal placement.
While it has been suggested as an option by the American Heart Association
and European Resuscitation Council
, it is seldom used outside of the pre-hospital, emergency setting, as it does not allow for long term airway control. Alternatives to the Combitube include the laryngeal mask airway
(LMA), the endotracheal tube, and other BIAD's such as the King Airway.
The Combitube was invented by Austrian researchers M.Frass M.D., R. Frenzer, and J. Zahler M.D.
Tracheal intubation
Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic or rubber tube into the trachea to maintain an open airway or to serve as a conduit through which to administer certain drugs...
of a patient in respiratory distress. It consists of a cuffed, double-lumen tube that is inserted into a the patient's airway facilitating ventilation. Inflation of the cuff allows the device to function similarly to an endotracheal tube and usually closes off the esophagus
Esophagus
The esophagus is an organ in vertebrates which consists of a muscular tube through which food passes from the pharynx to the stomach. During swallowing, food passes from the mouth through the pharynx into the esophagus and travels via peristalsis to the stomach...
, allowing ventilation
Ventilation (physiology)
In respiratory physiology, ventilation is the rate at which gas enters or leaves the lung. It is categorized under the following definitions:-Sample values:...
and preventing pulmonary aspiration
Pulmonary aspiration
Pulmonary aspiration is the entry of material from the oropharynx or gastrointestinal tract into the larynx and lower respiratory tract...
of gastric
Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract in some animals, including vertebrates, echinoderms, insects , and molluscs. It is involved in the second phase of digestion, following mastication .The stomach is...
contents.
The simplicity of placement is the main advantage of the Combitube over endotracheal intubation. When intubating with a traditional endotracheal tube, care must be taken to visually ensure that the tube has been placed in the trachea while the dual-lumen design of the Combitube allows for ventilation to proceed regardless of esophageal or tracheal placement. Generally, the tube enters the esophagus and ventilation is provided through tube number one. In the rare instance where the Combitube intubates the trachea, ventilation is provided through tube number two while tube one is clamped. A device called the Positube, which is a esophageal intubation detection device, can be used on tube number two to rule out the intubation of the Combitube in the trachea. The Positube checks for air flow resistance on tube number two and is very helpful in checking proper Combitube placement when intubation is performed in noisy environment's.
The Combitube's ease of use makes it ideal for use in the pre-hospital, emergency setting where advanced level providers capable of placing an endotracheal tube are often not immediately available. The drawbacks of Combitube use center around an inability to perform deep (subglottic) suctioning assuming esophageal placement.
While it has been suggested as an option by the American Heart Association
American Heart Association
The American Heart Association is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. It is headquartered in Dallas, Texas...
and European Resuscitation Council
European Resuscitation Council
The European Resuscitation Council is the European Interdisciplinary Council for Resuscitation Medicine and Emergency Medical Care. It was established in 1989....
, it is seldom used outside of the pre-hospital, emergency setting, as it does not allow for long term airway control. Alternatives to the Combitube include the laryngeal mask airway
Laryngeal mask airway
The laryngeal mask airway is a supraglottic airway device invented by Archie Brain, a British anaesthetist.-Description:Laryngeal masks consist of a tube with an inflatable cuff that is inserted into the pharynx. Laryngeal mask airways come in a variety of sizes ranging from large adult to infant...
(LMA), the endotracheal tube, and other BIAD's such as the King Airway.
The Combitube was invented by Austrian researchers M.Frass M.D., R. Frenzer, and J. Zahler M.D.