The term ETT is a medical acronym that stands for Endotracheal Tube, a device utilized to establish and maintain an open airway in a patient. This flexible, specialized tube is positioned directly into the trachea, or windpipe. The ETT bypasses a potentially compromised upper airway and connects the patient’s respiratory system directly to a source of mechanical ventilation. This intervention is a significant procedure performed when a person is unable to breathe or protect their airway independently.
Defining the Endotracheal Tube and Intubation
The Endotracheal Tube is typically a thin, curved device made of polyvinyl chloride, designed for insertion through the mouth or nose, past the vocal cords, and into the trachea. A feature of the adult ETT is a small balloon, known as the cuff, located near the tip. Once inflated, the cuff creates a seal against the tracheal wall, which prevents air leakage during positive-pressure ventilation. This seal also helps guard the lungs from stomach contents, blood, or other fluids. Attached to the cuff via a thin tube is a pilot balloon, which rests outside the patient’s mouth and allows medical staff to check the inflation status of the internal cuff.
The procedure of inserting the ETT is called Endotracheal Intubation. This is the definitive method for securing an airway and ensuring an unobstructed path for breathing. The external end of the ETT is connected to a mechanical ventilator, which assists or takes over the work of breathing entirely. The physical characteristics of the tube are designed to facilitate smooth insertion and maintain airflow.
Medical Situations Requiring Airway Management
The decision to perform endotracheal intubation is based on the patient’s need for advanced airway support, often categorized into three main clinical indications.
The first major category involves acute respiratory failure, where the patient cannot maintain adequate oxygen levels or expel enough carbon dioxide to sustain life. This can occur with severe lung infections like pneumonia or exacerbations of chronic obstructive pulmonary disease (COPD). In these situations, the patient’s breathing muscles may become fatigued, necessitating the ventilator support provided through the ETT.
The second primary indication is the need for airway protection, common in patients with a severely decreased level of consciousness. A person who is in a deep coma, has sustained a traumatic brain injury, or has suffered a stroke may lose the protective reflexes that prevent foreign material from entering the lungs. Intubation safeguards the airway by sealing the trachea with the inflated cuff, minimizing the risk of aspiration of stomach contents into the lungs.
The third indication is the requirement for controlled ventilation during general anesthesia, particularly for major surgical procedures. Anesthesia medications often temporarily paralyze the muscles involved in breathing, making independent breathing impossible. The ETT allows the anesthesiologist to precisely control the patient’s breathing, including the rate and volume of air delivered, and to safely administer inhaled anesthetic gases throughout the operation.
How the Tube is Placed and Removed
The placement of the endotracheal tube begins with the administration of sedative and sometimes paralytic medications to ensure the patient is unconscious and still during the procedure. This process is often called rapid sequence intubation in emergency settings, designed to be swift to minimize the time the airway is unprotected. A specialized instrument called a laryngoscope, which has a light source, is then used to visualize the vocal cords in the throat directly. The operator gently moves the tongue and epiglottis to gain a clear view of the opening to the trachea.
Once the vocal cords are visible, the tube is carefully guided through them into the trachea. Following insertion, the cuff is inflated with a specific volume of air, and the tube is secured to the patient’s face with tape or a specialized holder to prevent accidental dislodgement. Confirmation of correct placement is immediate and uses multiple methods. These include listening for breath sounds over both lungs and, most reliably, using a capnography device to detect carbon dioxide in the patient’s exhaled breath. A chest X-ray is typically performed shortly after to confirm the tube’s final position within the trachea.
While the patient remains intubated, they are continuously monitored and remain connected to the mechanical ventilator, which delivers precise breaths and oxygen concentrations. The duration of intubation varies widely, lasting from a few hours during a routine surgery to several weeks in cases of severe illness.
The process of removing the ETT is called extubation. This is performed only when the patient shows signs of sufficient recovery, such as being fully awake, having a strong cough reflex, and demonstrating the ability to breathe adequately on their own. During extubation, the tube’s securing device is removed, the cuff is deflated, and the patient is instructed to take a deep breath and cough as the tube is smoothly withdrawn. This timing is important to help clear any secretions that may have accumulated above the cuff. The medical team remains ready to re-intubate if the patient’s breathing ability declines after the tube is removed.
Common Risks and Post-Procedure Effects
Following the removal of the ETT, patients commonly experience a few temporary and minor effects in the throat and mouth area. A mild sore throat is the most frequent complaint, resulting from the presence of the tube passing through the vocal cords and resting in the trachea. Patients may also notice some degree of hoarseness or a slightly dry cough, which typically resolves completely within a few days to a week. These symptoms are generally managed with throat lozenges or ice chips.
The procedure of intubation carries a minor risk of temporary injury to the teeth, lips, or tongue during the insertion of the laryngoscope and the tube. Another temporary risk is irritation of the vocal cords that can lead to transient changes in voice quality. Though rare, complications require immediate detection and correction by the medical team. These include the tube inadvertently entering the esophagus or going too far into one of the main bronchi, a condition called endobronchial intubation.