Parham Salehi Saee1, MS4; Dhimitri A Nikolla, DO2
1Lake Erie College of Osteopathic Medicine, Erie, PA.
2Department of Emergency Medicine, Saint Vincent Hospital, Allegheny Health Network, Erie, PA.
Usually, blood or vomit in the oropharynx, a soiled airway can obscure relevant anatomy during laryngoscopy and make endotracheal intubation (ETI) more difficult. It has also been associated with reduced first pass success during emergency department ETI.1 Therefore, effective airway suctioning helps clear soiled airways and facilitates ETI.
Airway suctioning is usually performed with the Yankauer during emergent ETI. Although readily available, the Yankauer has poor suction rates compared to large-bore suction catheters.2-4 This paper summarizes recent studies comparing large-bore suction catheters to the Yankauer and reviews a couple of common airway decontamination techniques used during ETI of soiled airways.
Limitations of the Yankauer Compared to Large Bore Catheters
The Yankauer has a few disadvantages compared to large-bore suction catheters. The Yankauer has lower suction rates than large-bore suction catheters (Figure 1).2-5 These lower suction rates are likely due to the Yankauer’s small internal diameter compared to large-bore catheters (Figure 2).2-5 Even make-shift large-bore suction catheters, fashioned by connecting an endotracheal tube (ETT) to a meconium aspirator, had faster suction rates than the Yankauer.3-5 Second, the Yankauer may occlude more easily than large-bore catheters.4 Lastly, many Yankauer catheters have vent holes which will impair suction rates if unintentionally left open.2, 6
Figure 1 compares the suction rates of various suction catheters.2, 3 8.0ETT, 8.0mm endotracheal tube. (Click illustration to enlarge)
Figure 2 compares the minimum internal diameters of various suction catheters.2, 3 8.0ETT, 8.0mm endotracheal tube. (Click illustration to enlarge)
Techniques to Decontaminate Soiled Airways During ETI.
Two approaches to airway decontamination during ETI are suction-assisted laryngoscopy and airway decontamination (SALAD) and intentional esophageal intubation. SALAD technique involves initial suctioning of the oropharynx followed by laryngoscopy with continuous suctioning.7-10 In contrast, intentional esophageal intubation involves blindly placing an endotracheal tube into the esophagus and occluding the esophagus, which facilitates oropharyngeal suctioning and laryngoscopy.8
Large bore suction catheters have higher suction rates than the Yankauer suction catheter.2-5 SALAD technique and intentional esophageal intubation may facilitate decontamination and ETI of the soiled airway.8, 10 However, literature on suction catheter efficacy and decontamination techniques is limited to experimental and simulation studies. Therefore, it is unknown if large-bore catheters and dedicated airway decontamination techniques improve clinical outcomes during emergent ETI of soiled airways.