Is it true that in ICU, adults get ventilated with pipe via mouth, while children get a trach (not via mou?
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All ages would get a oral endotrachial tube (ET tube) as the first way of establishing an artificial airway. Sometimes, when there is no evidence of skull fractures, at the discretion of the person intubating (placing the ET tube), the tube could be inserted via the nose. This is more difficult to do and the tube size is smaller, leading to the potential of having a harder time getting the patient off the ventilator.
A larger ET tube can be placed via the mouth, making ventilator weaning less difficult. It also helps lower ventilating pressures and is the most common artificial airway in use today. Since most people are on mechanical ventilation or need an artificial airway for a few hours or days, this works for most situations. For example: if you have surgery under general anesthesia, you will have an ET tube via your mouth for that. It's in for a few hours, then you don't need it any more and it gets taken out. There is no justification to go through the procedure of placing a trach for that situation.
The tracheostomy (or trach) is used for people with upper airway problems, facial trauma, croup (specially found in children), and people who need an artificial airway for extended periods of time (longer than 24 hours, or longer than a week, depending on what specialty of doctor you ask). It's less invasive to live with, allows the patient to be conscious, eat, brush their teeth, talk (with a speaking valve), while being ventilated or protecting their airway. In addition, trach patients in the home can have their airway cleaned/changed by trained family members. If the trach comes out for some reason, it doesn't require specialized equipment and training like an ET tube does. A layperson can't place an ET tube. A trach is easier to care for and allows for greater patient comfort and abilities.
When babies are born prematurely, they often need mechanical ventilation. This must be done with an ET tube (a tiny one), until the baby has airway structures large enough to safely attempt placement of a trach. The death rate for trachs in babies/children is about 5%, mostly because of difficulty placing it - small structures are easy to damage and there's a very important artery between the trachea and esophagus that would result in death if it were punctured.
Anyone can be ventilated via mouth, nose or tracheaa. Young and old alike. There are various size tubes for children and adults for each location. A trache is generally a last resort.
Any one can be intubated with an ETT (endotracheal tube) and put on a ventilator. Tracheostomies are done on adults AND children when it looks like they will need ventilatory support for quite some time as it is more comfortable than having an ETT down the throat, and allows them to move about better, is safer, and much easier to take care of & won't cause erosion of the nose like a long-term ETT will. Once the need for a ventilator has passed, the trach can be closed (Elizabeth Taylor had this done). Both ETT and trach tubes both go into the trachea (the lungs) regardless of where they start; and most ETT are placed in the nose if at all possible rather than the mouth for any long term support. The mouth is used for very short term intubation.
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