Contraindications to endotracheal intubation

Tracheal intubation is a very important technique in emergency treatment. It has been widely used in situations where the patient suddenly stops breathing on his own, the body's oxygen supply cannot be met, or there is acute respiratory failure. It has greatly reduced the patient mortality rate. However, tracheal intubation is not a panacea and has its own scope of application and contraindications. So, what are the contraindications of endotracheal intubation?

Indications for endotracheal intubation

1. Patients with respiratory insufficiency or respiratory failure who need pressurized oxygen and assisted breathing.

2. It facilitates respiratory tract management and intratracheal drug administration during general anesthesia.

3. Patients undergoing cardiopulmonary and cerebral resuscitation due to cardiac and respiratory arrest.

4. Respiratory secretions cannot be coughed out by themselves and require endotracheal suction.

5. Gastric contents are refluxed and accidentally inhaled into the lungs, requiring endotracheal suction.

6. Infants and young children who need endotracheal tube positioning before tracheotomy.

Contraindications to endotracheal intubation

1. Absolute contraindications: Laryngeal edema, acute laryngitis, laryngeal submucosal hematoma, and intubation trauma can cause severe bleeding. Unless the patient is in emergency treatment, endotracheal intubation is contraindicated in the above cases.

2. Relative contraindications:

1) Patients with incomplete airway obstruction are suitable for intubation, but rapid induction intubation is contraindicated.

2) For patients with coexisting hemorrhagic blood diseases (such as hemophilia, thrombocytopenic purpura, etc.), intubation trauma can easily lead to laryngeal, glottic or tracheal submucosal bleeding or hematoma, followed by acute respiratory obstruction.

3) For patients whose aortic aneurysm compresses the trachea, intubation may cause aneurysm rupture, which is a relative contraindication. If endotracheal intubation is necessary, the movements must be skillful and gentle to avoid accidental trauma.

4) Patients with obstructed nasal passages, nasopharyngeal angiofibroma, nasal polyps, or a history of recurrent epistaxis are contraindicated for nasotracheal intubation.

5) If the operator does not have the basic knowledge of intubation, is not proficient in intubation techniques, or has incomplete intubation equipment, it should be listed as a relative contraindication.