Question

Problem / Situation	Possible cause(s)	Intervention or recommendation
Clinical evidence of impeding respiratory failure
Clinical Evidence of inadequate airway protection
Difficult intubation
Excessive ETT cuff leak despite air being added to the pilot balloon
Intubation indicated in the presence of facial or mandibular trauma or pathology
Oral ETT in place but the need for long term ventilation exists
Trach tube in place but patient with good upper airway control whishes to talk
Need to maintain an airway without an indication for artificial ventilation
The patient has an artificial airway, but suction catheter cannot be passed
Artificial airway no longer indicated
Need for mechanical ventilation in a patient with unilateral lung diseases.

Answer 1

1. CLINICAL EVIDENCE OF RESPIRATORY FAILURE-

Symptoms of respiratory failure depend on its cause, the levels of oxygen and carbon dioxide in your blood, and whether respiratory failure developed slowly over time or suddenly. You may start out with mild symptoms such as shortness of breath or rapid breathing, which may get worse over time. Acute respiratory failure can be a life-threatening emergency. Respiratory failure may cause damage to your lungs and other organs, so it is important to get treated quickly.

Signs and symptoms
Low oxygen levels in your blood can cause:

Difficulty or extreme tiredness with routine activities such as dressing, taking a shower, and climbing stairs
Shortness of breath or feeling like you cannot get enough air (called air hunger)
Drowsiness
A bluish color on your fingers, toes, and lips
High carbon dioxide levels in your blood can cause:

Blurred vision
Confusion
Headaches
Rapid breathing
You can have symptoms of low oxygen and high carbon dioxide at the same time. Some people who have respiratory failure become extremely sleepy or lose consciousness if their brain does not get enough oxygen or if carbon dioxide levels are very high.

Symptoms of respiratory failure in newborns include rapid breathing, grunting, widening of the nostrils with each breath, a bluish tone to your baby's skin and lips, and a pulling inward of the muscles between the ribs between the ribs while breathing.

2. DIFFICULT INTUBATION-

An intubation is called difficult if a normally trained anesthesiologist needs more than 3 attempts or more than 10 min for a successful endotracheal intubation."

Causes-

The main factors implicated in difficult endotracheal intubation were poor dental condition in young patients, low Mallampati score and interincisor gap in middle-age patients, and high Mallampati score and cervical joint rigidity in elderly patients.

Management-

Gas exchange can be maintained using mask ventilation after re-establishing the patency of the upper airway – or by use of a tube that entirely bypasses the upper airway, passing through the glottis directly into the trachea.

3. Excessive ETT cuff leak despite air being added to the pilot balloon-

A. The reason of excessive cuff leak despite air being added to the pilot ballon may be due to the break in cuff.

B. Incompetent pilot ballon.

C. Subglottic secretion drainage ETT

D. Trachial wall - ETT Cuff gap

E. Tracheomalacia

F. Anatomical distortion of trachea.

G. ETT CUFF below the glottis.

H. ETT cuff above trachea.

4. Patient has an artificial airway, but suction catheter cannot passed-

The reason of not passing suction cath may be clogged secretion. This can be removed by the administration of 1-2 ml soda bicarbonate just before suction in trachea.