 Description:
The
Combitube™ is a double-lumen tube with
one blind end which functionsas an esophageal obturator airway
and the other as a standard cuffed ET tube. It is inserted blindly
and "seals" the oral and nasal pharyngeal cavities.
Indications:
- Ventilation
in normal and abnormal airways
- Failed
intubation
- Airway
management in trapped patients
Contraindications:
- Patients
with intact gag reflexes
- Patients
with known esophageal pathology
- Use
in patients under 5 feet with standard Combitube™, under
4 feet with Combitube™ SA (small adult)
-
Requires minimal training
-
May
be more useful in non-fasted patients
-
Successful
passage and ventilation in many patients via esophageal route
-
Portable,
useful in remote setting
-
Functions
in either the trachea or esophagus
Disadvantages:
- Mostly
adult sizes
- Potential
for esophageal trauma
- Problems
maintaining seal in some patients
Special
Features:
- Curve
the distal tip ("Lipp maneuver") just prior to insertion
- Withdraw
gently from the airway if ventilation is inadequate
- Use
the laryngoscope
Currently available devices:
For
additional information contact www.combitube.org
References:
-
Frass
M, Frenzer R, Rauscha F, et al. "Ventilation with the Esophageal
Tracheal Combitube in Cardiopulmonary Resuscitation." Critical
Care Medicine 15:609, 1987.
-
American
Society of Anesthesiologists Task Force on Management of the
Difficult Airway. "Practice Guidelines for Management of
the Difficult Airway." Anesthesiology 78:597, 1993.
-
Gaitini
LA, Vaida SJ, Somri M, Fradis M. "Fiberoptic-guided Airway
Exchange of the Esophageal-tracheal Combitube in Spontaneously
Breathing versus Mechanically Ventilated Patients." Anesth
Analg. 1999 Jan;88(1):193-6.
-
Gaitini
LA, Vaida SJ, Mostafa S, Yanovski B, Croitoru M, Capdevila MD,
Sabo E, Ben-David B, Benumof J. "The Combitube in Elective
Surgery: A Report of 200 Cases." Anesthesiology.
2001 Jan; 94(1):79-82.
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