Chart — Airway Management
Airway Adjuncts Comparison Chart
Airway adjuncts run a spectrum — from a simple OPA that just holds the tongue forward, to a cuffed endotracheal tube that fully isolates the trachea. The right choice depends on how awake the patient is and what you are trying to accomplish. This chart lines up the OPA, NPA, supraglottic airway, and ETT so you can match the device to the patient.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Airway Adjuncts Side by Side
| Device | Indication / Conscious Level | Aspiration Protection | Sizing / Placement | Key Notes |
|---|---|---|---|---|
| Oropharyngeal airway (OPA) | Unconscious patient with NO gag reflex | None | Sized corner of mouth to angle of mandible | Triggers gag or vomiting if the gag reflex is intact; holds the tongue off the pharynx |
| Nasopharyngeal airway (NPA) | Obtunded patient with the gag reflex intact | Minimal | Sized nare to tragus of the ear | Avoid in suspected basilar skull fracture; lubricate before insertion |
| Supraglottic airway (LMA and similar) | Rescue, failed intubation, or short procedures | Partial — not definitive | Blind insertion seating over the larynx | A temporizing bridge to a definitive airway; does not fully protect against aspiration |
| Endotracheal tube (ETT) | Definitive airway: failed oxygenation/ventilation or airway protection | Full (inflated cuff) | Requires laryngoscopy; sized by internal diameter | The gold-standard definitive airway; confirm placement with waveform capnography |
Clinical Notes
- Adjuncts hold, they do not seal. An OPA and NPA keep soft tissue off the airway but do not protect it from aspiration.
- Supraglottic is a bridge. A supraglottic airway is a rescue device, not a definitive airway — plan for a definitive airway behind it.
- Only a cuff gives full protection. Only a cuffed ETT (or a tracheostomy) gives full aspiration protection.
- Match the device to the patient. Match the device to the patient’s level of consciousness and the clinical goal.
Related Resources
Sources
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021.
- Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;136(1):31-81.