Intubation is a procedure for patients who cannot breathe on their own. A healthcare professional inserts a flexible plastic endotracheal tube through the mouth or nose into the trachea (windpipe). This tube connects to a mechanical ventilator, a life-support machine that takes over breathing. The ventilator pushes a controlled mixture of air and oxygen into the lungs, securing the airway until the patient can breathe independently.
When Intubation Becomes Necessary for COVID-19 Patients
Severe COVID-19 can lead to a serious lung condition known as Acute Respiratory Distress Syndrome (ARDS). In ARDS, the virus causes widespread inflammation that damages the alveoli, the tiny air sacs where oxygen passes into the bloodstream. As a result, fluid leaks into the alveoli, making it difficult for the lungs to fill with air and transfer oxygen to the body.
This lack of oxygen, called hypoxemia, is a primary reason for intubation in COVID-19 patients. Doctors monitor blood oxygen levels, and if they drop dangerously low despite other oxygen support, it signals lung failure. Other signs of distress include rapid, shallow breathing and visible exhaustion from the effort to breathe. A respiratory rate over 30 breaths per minute is a common indicator.
Before deciding to intubate, medical teams try less invasive methods to improve oxygenation. These can include delivering oxygen through a high-flow nasal cannula (HFNO) or using non-invasive ventilation (NIV) with machines like CPAP or BiPAP, which use a mask to deliver pressurized air. If a patient’s condition continues to worsen despite these interventions, intubation becomes the necessary next step to ensure the body gets the oxygen it needs to survive.
The Intubation Procedure
The intubation process is managed for patient safety and comfort. Before the procedure, the patient receives a combination of medications. A sedative is administered to induce unconsciousness, while a paralytic medication relaxes the body’s muscles, including the throat and vocal cords, to prevent gagging during tube placement.
Once sedated and paralyzed, a physician uses a laryngoscope to get a clear view of the vocal cords and guide the endotracheal (ET) tube into the windpipe. After insertion, the team confirms correct placement by listening for breath sounds and checking for exhaled carbon dioxide. Once placement is verified, the tube is secured with tape or a holder and connected to the mechanical ventilator, which begins delivering controlled breaths.
Managing Patient Care During Mechanical Ventilation
While on a mechanical ventilator, patients receive continuous care in the intensive care unit (ICU). They are kept under sedation to remain comfortable and to allow the ventilator to control breathing without interference from natural reflexes. This sedation helps reduce the body’s oxygen consumption and allows the lungs to rest. Vital signs like heart rate, blood pressure, and oxygen levels are constantly monitored.
The settings on the mechanical ventilator are actively managed by respiratory therapists and physicians. They frequently adjust the amount of oxygen, air pressure, breath volume, and breathing rate. These adjustments are based on regular assessments, including blood tests and observations of lung function, to provide support while minimizing ventilator-induced lung injury.
Patients on ventilators also receive comprehensive supportive care. Because they cannot eat, nutrition is provided through a feeding tube that delivers a liquid formula to the stomach or intestines. The care team also takes measures to prevent health issues associated with being immobilized, such as frequent repositioning to prevent bedsores, specific oral hygiene to reduce the risk of ventilator-associated pneumonia (VAP), and medications to prevent blood clots.
The Process of Coming Off the Ventilator
The process of coming off the ventilator, known as weaning, begins once the underlying lung injury from COVID-19 shows signs of healing. Weaning is initiated when the medical team observes consistent improvement, such as better oxygen levels and resolving inflammation. This gradual process is tailored to the individual patient’s readiness and strength.
A step in this process is the spontaneous breathing trial (SBT). During an SBT, ventilator support is reduced for a set period, allowing the patient to attempt breathing on their own. The medical team watches for signs of success, like stable breathing, or signs of distress that indicate the patient is not yet ready. These trials may be performed daily to build respiratory muscle strength.
If a patient successfully passes a spontaneous breathing trial, the team prepares for extubation. This involves deflating the cuff that holds the endotracheal tube in place and removing the tube from the trachea. After extubation, a patient may experience a sore throat or a weak cough. They are monitored closely by medical staff to ensure they can continue to breathe effectively and keep their airway clear.