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Endotracheal Intubation: Click here to read the key points of this article.
Purpose of Intubation: Endotracheal intubation helps maintain breathing during emergencies, bad infections or surgery.
The Procedure: A flexible tube is inserted into the airway (trachea) under anesthesia (medication to put you to sleep) and secured with a balloon and tape. A ventilator or bag delivers air to the lungs.
Risks: Minor side effects include a sore throat or hoarseness, while serious risks can include bleeding, infection, lung collapse, or airway damage.
Extubation and Recovery: Removing the tube (extubation) is quicker than insertion. Recovery can involve mild symptoms like throat soreness, coughing, or voice changes, typically resolving within hours to days.
Endotracheal intubation is a procedure that can help save a life when someone is unable to breathe.
A flexible tube is inserted into your mouth, down your throat, and into your lungs to allow you to breathe. It’s usually done in an emergency situation or before surgery.
Your age and throat size determine the size of the tube used. After inserting the tube, a small cushion of air expands around the tube to hold it in place.
Once in place, the tube is connected to a machine called a ventilator (or, for a short time, a bag that is squeezed), which moves the air in and out of your lungs.
A highly skilled doctor called an anesthesiologist provides anesthesia to you before your procedure. These medications…
Put you to sleep and keep you asleep until the procedure is done.
Make it easier to put the tube in.
Make the procedure more comfortable.
Help reduce pain.
Help you to keep still during the procedure. (5)
Other health care providers, such as a nurse anesthetist, paramedic, respiratory therapist, or other qualified doctors, might also intubate you in some circumstances.
Why Would You Need to Be Intubated?
To prevent your throat from closing in emergencies like allergic reactions. (2)
During certain illnesses, your body may need extra support to breathe. For example, if you had severe pneumonia (a lung infection) or chronic obstructive pulmonary disease (COPD), a disease that restricts airflow into and out of the lungs.
To clear blockages from the throat. (3)
To help the health care provider see the airway better and figure out what's wrong with your lungs.
To protect the lungs in people who cannot protect their airway and are at risk of fluids entering their lungs (aspiration). (6)
This includes people who have had a stroke and cannot swallow properly. Or people who use too many drugs and lose the ability to breathe on their own.
During surgery, which will leave you unable to breathe on your own.
Is Intubation Safe?
If you’re worried about your safety and risks associated with intubation, here’s what you need to know.
Endotracheal intubation is one of the most common and high-risk procedures in critical care. If you are being intubated in an emergency situation or before surgery, the benefits typically outweigh the risks.
Intubation usually results in only minor side effects like a sore throat and a raspy voice. Some people have no symptoms and don't even know that they were intubated. (2)
Intubation Risks
Getting cut on your lips and tongue.(1)
Getting your tooth chipped.
Corneal abrasion (getting a scratch on the clear tissue that covers the front of your eye).
Gagging or choking.
Bleeding.
Infection.
Damage to the voice box (larynx) and throat.
A small hole or tear inside your chest wall, causing your lung to collapse.
A hole in the esophagus (the tube that carries food and liquid from your mouth to your stomach.)
Not being able to come off the ventilator and needing to have a surgical procedure to insert a tube directly into the neck and down the windpipe (the tube that goes into your lungs) to help with breathing.
Who Should Not Be Intubated?
People who have bad damage or blockage in their throat, which prevents the tube from safely passing through the windpipe. (2)
People who have bad injuries to the neck or spine.
People who have bad injuries to their face or head.
What to expect during intubation
During the intubation procedure, your healthcare provider will:
Insert an intravenous (IV), a small cannula that goes into your arm. (2)
Provide medications through the IV that cause you to sleep, prevent pain, and keep you from moving during the procedure (anesthesia).
Put an oxygen mask on your face to increase your oxygen levels.
Take the mask off.
Stand above your head, then position your head back and insert a tool called a laryngoscope (which has a light, handle, and a dull blade) to help see the areas of your throat better.
Move the tip of the laryngoscope into your voice box and then into your trachea. (5)
While keeping your mouth open with the laryngoscope, insert the endotracheal tube into your mouth and down into your lungs.
Inflate a small balloon around the endotracheal tube to make sure it stays in the windpipe and that all the air gets to the lungs.
Take out the laryngoscope.
Make sure the endotracheal tube stays in place with tape or a strap that goes around your head.
Make sure the tube is in the right place by taking an X-ray, by squeezing air through a bag into the tube, and listening for breathing. Or by measuring end-tidal CO2 (ET-CO2), which lets the health care provider know how well CO2 gas is coming out of the lungs.
How Is The Endotracheal Tube Removed?
The endotracheal tube is removed through extubation, which is usually easier and faster than putting the tube in.
Extubation involves the following steps:
Removing the tape or strap holding the tube in place.
Suctioning any extra fluid left in the airway.
Making sure you can support your airway. This is done by making sure you can follow commands like lifting your head or sticking your tongue out.
Removing the air from the balloon inside your windpipe that's keeping the tube in place.
Gently pulling out the tube in one motion.
What to expect during recovery
During recovery your throat might be sore, your voice may be hoarse, or you might have a cough for a few days. Recovery is usually quick, lasting a few hours to a few days, depending on how long you were intubated. (4)
Summary
Endotracheal intubation is a procedure where a flexible tube is placed into the mouth to allow you to breathe. It is usually done in emergencies or before surgery.
An anesthesiologist provides anesthesia to help you sleep, make the procedure more comfortable, reduce pain, and maintain a steady state.
Intubation is necessary to prevent throat closure, clear blockages, and protect the lungs in those who cannot protect their airway.
Risks include cuts, tooth chips, corneal abrasion, gagging, bleeding, infection, damage to the voice box and chest wall, and being on the ventilator longer than expected.
The endotracheal tube is removed through extubation, which involves removing the tube, suctioning excess fluid, and supporting the airway.
Recovery may involve sore throat, hoarse voice, and coughing but is usually quick.
References
Hernandez, C. A. (2019). Endotracheal intubation: A life-saving procedure. Hospital Medicine, 80(8), 441. https://doi.org/10.12968/hmed.2019.80.8.441
Louisiana State University Health Sciences Center. (n.d.). Endotracheal intubation procedure manual. LSUHSC School of Medicine. Retrieved December 2, 2024, from https://www.medschool.lsuhsc.edu/medical_education/undergraduate/csi/Procedure%20Manual/endotracheal.html
MedlinePlus. (n.d.). Airway obstruction. MedlinePlus. Retrieved Dec 2, 2024, from https://medlineplus.gov/ency/article/007738.htm
MedlinePlus. (n.d.). Endotracheal intubation. MedlinePlus. Retrieved Dec 2, 2024, from https://medlineplus.gov/ency/article/003449.htm
Nallapaneni, V., & Keesara, S. (2023). Airway management and intubation. In StatPearls. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK470403/
Smith, J. B., & Patel, R. K. (2020). Understanding endotracheal intubation in critical care. British Journal of Cardiac Nursing, 15(9), 93. https://doi.org/10.12968/bjca.2020.0093
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