Editing Tracheal intubation (section)

===Tracheal tubes {{anchor|Types of tracheal tube}}===
{{Main|Tracheal tube}}
[[Image:Sondeintubation.jpg|thumb|alt=a cuffed endotracheal tube|A cuffed endotracheal tube, constructed of [[polyvinyl chloride]]]]
[[File:Carlens.jpg|thumb|alt=A Carlens double-lumen endotracheal tube|A Carlens double-lumen endotracheal tube, used for [[thoracic surgery|thoracic surgical]] operations such as [[VATS lobectomy]]]]

A tracheal tube is a catheter that is inserted into the trachea for the primary purpose of establishing and maintaining a patent (open and unobstructed) airway. Tracheal tubes are frequently used for [[airway management]] in the settings of general anesthesia, critical care, mechanical ventilation, and emergency medicine. Many different types of tracheal tubes are available, suited for different specific applications. An endotracheal tube is a specific type of tracheal tube that is nearly always inserted through the mouth (orotracheal) or nose (nasotracheal). It is a [[breathing]] conduit designed to be placed into the airway of critically injured, ill or anesthetized patients in order to perform mechanical [[positive pressure ventilation]] of the lungs and to prevent the possibility of aspiration or airway obstruction.<ref name=Adair1992/> The endotracheal tube has a fitting designed to be connected to a source of pressurized gas such as oxygen. At the other end is an orifice through which such gases are directed into the lungs and may also include a balloon (referred to as a cuff). The tip of the endotracheal tube is positioned above the [[Carina of trachea|carina]] (before the trachea divides to each lung) and sealed within the trachea so that the lungs can be ventilated equally.<ref name=Adair1992/> A tracheostomy tube is another type of tracheal tube; this {{convert|50|-|75|mm|in|adj=mid|-long}} curved metal or plastic tube is inserted into a tracheostomy [[Stoma (medicine)|stoma]] or a cricothyrotomy incision.<ref name=NatCancInst/>

Tracheal tubes can be used to ensure the adequate [[gas exchange|exchange]] of oxygen and [[carbon dioxide]], to deliver oxygen in higher concentrations than found in air, or to administer other gases such as [[helium]],<ref name=Tobias2009/> [[nitric oxide]],<ref name=Chotigeat2007/> nitrous oxide, [[xenon]],<ref name=Goto2003/> or certain volatile anesthetic agents such as [[desflurane]], [[isoflurane]], or [[sevoflurane]]. They may also be used as a route for administration of certain medications such as [[bronchodilator]]s, [[Inhaled corticosteroid#Inhaled steroids|inhaled corticosteroids]], and drugs used in treating [[cardiac arrest]] such as [[atropine]], [[epinephrine]], [[lidocaine]] and [[vasopressin]].<ref name=AHA2005-III/>

Originally made from [[Natural rubber|latex rubber]],<ref name=Macewen18800731/> most modern endotracheal tubes today are constructed of [[polyvinyl chloride]]. Tubes constructed of [[silicone rubber]], wire-reinforced silicone rubber or [[stainless steel]] are also available for special applications. For human use, tubes range in size from {{convert|2|to|10.5|mm|in|1|abbr=on}} in internal diameter. The size is chosen based on the patient's body size, with the smaller sizes being used for infants and children. Most endotracheal tubes have an inflatable cuff to seal the tracheobronchial tree against leakage of respiratory gases and pulmonary aspiration of gastric contents, blood, secretions, and other fluids. Uncuffed tubes are also available, though their use is limited mostly to children (in small children, the [[cricoid cartilage]] is the narrowest portion of the airway and usually provides an adequate seal for mechanical ventilation).<ref name=Wheeler2007/>

In addition to cuffed or uncuffed, preformed endotracheal tubes are also available. The oral and nasal RAE tubes (named after the inventors Ring, Adair and Elwyn) are the most widely used of the preformed tubes.<ref name=Ring1975/>

There are a number of different types of [[double-lumen endo-bronchial tube]]s that have endobronchial as well as endotracheal channels (Carlens, White and Robertshaw tubes). These tubes are typically [[coaxial]], with two separate channels and two separate openings. They incorporate an endotracheal lumen which terminates in the trachea and an endobronchial lumen, the distal tip of which is positioned 1–2&nbsp;cm into the right or left mainstem bronchus. There is also the Univent tube, which has a single tracheal lumen and an integrated [[endobronchial blocker]]. These tubes enable one to ventilate both lungs, or either lung independently. Single-lung ventilation (allowing the lung on the operative side to collapse) can be useful during [[thoracic surgery]], as it can facilitate the surgeon's view and access to other relevant structures within the [[thoracic cavity]].<ref name=Sheinbaum2007/>

The "armored" endotracheal tubes are cuffed, wire-reinforced silicone rubber tubes. They are much more flexible than polyvinyl chloride tubes, yet they are difficult to compress or kink. This can make them useful for situations in which the trachea is anticipated to remain intubated for a prolonged duration, or if the neck is to remain flexed during surgery. Most armored tubes have a Magill curve, but preformed armored RAE tubes are also available. Another type of endotracheal tube has four small openings just above the inflatable cuff, which can be used for suction of the trachea or administration of intratracheal medications if necessary. Other tubes (such as the Bivona Fome-Cuf tube) are designed specifically for use in laser surgery in and around the airway.<ref name=Rosenblatt2009/>