Which artificial airway is most appropriate for a patient in acute ventilatory failure and requiring intubation?

• A. Size 8.0 mm ET tube with a small volume, high pressure cuff
• B. Jackson tracheostomy tube
• C. Size 7.5 mm fenestrated tracheostomy tube
• D. Size 7.0 mm ET tube with a large volume, low pressure cuff

Answer: (D)

The most appropriate choice for a patient in acute ventilatory failure who requires intubation is a size 7.0 mm endotracheal (ET) tube with a large volume, low pressure cuff. This option is ideal because it allows for effective ventilation while minimizing the risk of injury to the airway.

The use of a large volume, low pressure cuff reduces the risk of ischemic injury to the tracheal wall by distributing the cuff pressure over a greater surface area. This is especially important in patients who may require prolonged intubation, as it helps maintain mucosal perfusion and reduces the likelihood of tracheal necrosis. The size of the ET tube (7.0 mm) is typically appropriate for most adult patients, providing an adequate lumen for ventilation and secretions while allowing for easier airflow.

In contrast, other options may not provide the same level of safety or effectiveness. A size 8.0 mm ET tube may be too large for some patients, increasing the risk of trauma. Jackson tracheostomy tubes are primarily used for patients requiring long-term ventilation and are not suitable for acute intubation. A size 7.5 mm fenestrated tracheostomy tube is also more appropriate for patients who