Airway adjuncts are medical devices that establish and maintain an open pathway for air to flow into and out of the lungs. They are used in emergency and medical settings when a patient’s natural breathing is compromised. These tools help ensure oxygen delivery to the body’s tissues. They are temporary solutions until more definitive airway management can be achieved or the patient recovers.
Understanding Airway Obstruction
An obstructed airway prevents oxygen from reaching the lungs, leading to a rapid decrease in oxygen levels and potentially cardiac arrest. A common cause in unconscious individuals is the relaxation of jaw and tongue muscles, allowing the tongue to fall backward and block the windpipe, impeding airflow.
Other factors include swelling from allergic reactions or infections, trauma to the head and neck, foreign objects, or secretions like vomit and blood. Prolonged obstruction can lead to severe consequences, including lack of oxygen to the brain and other organs, potentially resulting in brain injury and death.
How Airway Adjuncts Restore Airflow
Airway adjuncts work by mechanically creating or maintaining an open channel for air to pass. Their primary function is to address obstructions in the upper airway, often caused by the tongue or soft tissues. By physically displacing these structures, they establish a patent pathway for breathing.
They ensure a continuous flow of air, particularly when manual airway maneuvers alone are insufficient to clear an obstruction. The mechanical action of these adjuncts helps restore effective ventilation and oxygenation.
Common Types and Uses
Several types of airway adjuncts are available, each designed for specific situations to help maintain an open airway.
Oral Pharyngeal Airway (OPA)
The Oral Pharyngeal Airway (OPA) is a rigid, curved plastic device inserted into the mouth. Its purpose is to prevent the tongue from falling back and obstructing the upper airway, particularly in unconscious patients. OPAs are used in patients who do not have an intact gag reflex, as insertion in a conscious or semi-conscious patient could induce vomiting and increase the risk of aspiration. Proper sizing involves measuring the device from the corner of the patient’s mouth to the angle of their jaw.
Nasal Pharyngeal Airway (NPA)
The Nasal Pharyngeal Airway (NPA) is a soft, flexible tube inserted through the nostril into the posterior pharynx. This adjunct is useful for maintaining an open airway when an OPA is not tolerated, such as in patients with an intact gag reflex, or when the mouth is inaccessible due to trauma or jaw clenching. NPAs bypass obstructions at the level of the nose, nasopharynx, or the base of the tongue. These devices are well-tolerated in conscious or semi-conscious patients.
Advanced Airway Adjuncts
Beyond basic adjuncts, more advanced devices like the Laryngeal Mask Airway (LMA) and Endotracheal Tube (ETT) are used for comprehensive airway management. A Laryngeal Mask Airway is a supraglottic device that forms a seal over the larynx, providing a channel for oxygen and anesthetic gases to the lungs. LMAs are used during general anesthesia for shorter procedures or as a rescue airway in difficult intubation scenarios, and they are easier to place than ETTs.
An Endotracheal Tube (ETT) is a flexible tube inserted directly into the trachea, either through the mouth or nose, to provide a definitive and secure airway. ETTs are used for mechanical ventilation, protecting the lungs from aspiration, and during prolonged anesthesia or in critical care settings where extended breathing support is needed. Both LMAs and ETTs require specialized training for proper insertion and management.