Intubation is a medical procedure that involves inserting a tube, known as an endotracheal tube, into the windpipe, or trachea. This is typically done through the mouth or nose. The primary purpose is to secure an open pathway for air to travel to the lungs, and the tube can be connected to a machine that delivers oxygen. The procedure is also referred to as endotracheal or tracheal intubation.
The Purpose of Intubation
A common reason for intubation is during surgery that requires general anesthesia. The medications used to induce unconsciousness can also suppress a patient’s natural ability to breathe. Intubation allows an anesthesiologist to control the breathing process, delivering a precise mixture of oxygen and anesthetic gases throughout the operation.
Intubation is also performed for respiratory failure. This condition can result from severe illnesses like pneumonia, acute respiratory distress syndrome (ARDS), or significant trauma. When a person is unable to breathe sufficiently on their own, their body cannot obtain the needed oxygen or effectively remove carbon dioxide. The breathing tube provides a direct channel to the lungs for mechanical support.
Protecting the airway is another reason for intubation. In patients who are unconscious or have experienced facial or neck trauma, the airway can become blocked by swelling or other injuries. There is also a significant risk of aspiration, which occurs when stomach contents are inhaled into the lungs, in individuals with a diminished level of consciousness from stroke or overdose.
The Intubation Procedure
Before the procedure begins, the patient is administered medications to induce sedation and temporary muscle paralysis. These drugs ensure the patient is comfortable and prevent natural reflexes like gagging, which could interfere with the tube’s placement. To increase oxygen levels in the blood, the patient may breathe pure oxygen from a mask for a few minutes prior to the insertion attempt.
A healthcare provider, often an anesthesiologist or emergency physician, then uses a laryngoscope, a device with a light and a blade, to see the back of the throat. The laryngoscope is carefully inserted into the mouth to lift the tongue and epiglottis out of the way, providing a direct line of sight to the vocal cords.
With the vocal cords in view, the endotracheal tube is gently passed through them and advanced into the trachea. The tube is positioned so its tip sits above the carina, the point where the trachea divides into the two main bronchi of the lungs. Once the tube is in place, a small balloon cuff near the end of the tube is inflated with air. This cuff seals against the tracheal walls to ensure that all delivered air goes into the lungs and to protect against aspiration.
Confirming the tube’s correct placement is the final step. The provider will listen for breath sounds over both lungs with a stethoscope and observe the chest for equal rise and fall. A capnography device, which measures the carbon dioxide in exhaled air, is used to provide immediate verification that the tube is in the trachea and not the esophagus. A chest X-ray may also be performed for definitive confirmation of the tube’s depth and position.
Potential Complications
Minor and common side effects can occur following intubation. A sore throat and a hoarse voice are frequent complaints, resulting from the tube passing by and resting near the vocal cords. Minor damage to the soft tissues of the mouth, lips, or teeth can also occur during the insertion of the laryngoscope and tube. These issues are typically temporary and resolve on their own after the tube is removed.
Less frequently, more significant issues can arise. Injury to the vocal cords or the trachea itself can happen. One of the more serious potential errors is incorrect tube placement, such as inserting the tube into the esophagus instead of the trachea. If not quickly identified and corrected, this can prevent oxygen from reaching the lungs.
Another risk associated with being intubated for an extended period is ventilator-associated pneumonia. This lung infection can develop because the breathing tube can allow bacteria to enter the lower respiratory tract. Healthcare providers take specific precautions to minimize this risk, but it remains a concern for patients requiring prolonged mechanical ventilation.
Life After Intubation
After successful intubation, the endotracheal tube is connected to a mechanical ventilator. This machine then takes over the work of breathing, either by fully controlling breaths or by providing support to the patient’s own breathing efforts. The ventilator settings are adjusted to meet the individual’s specific oxygen and ventilation needs while they recover from their underlying condition.
The process of removing the breathing tube is called extubation. This is considered when the original reason for intubation has resolved and the patient demonstrates the ability to breathe effectively on their own. Before removal, providers assess respiratory function to ensure the patient can maintain a clear airway and breathe without assistance.
After the tube is removed, it is common to have a sore throat or a weak, breathy voice for a short time. These symptoms typically improve within a few days as the irritation and swelling in the throat and around the vocal cords subside. Patients are monitored closely following extubation to ensure they continue to breathe comfortably and without difficulty.