Intubation: what it is, when it is practised and what are the risks associated with the procedure

By Cristiano Antonino On Feb 28, 2023

Intubation is a procedure that can help save a life when someone can’t breathe

A healthcare provider uses a laryngoscope to guide an endotracheal tube (ETT) into the mouth or nose, voicebox, then trachea.

The tube keeps the airway open so air can get to the lungs. Intubation is usually performed in a hospital during an emergency or before surgery.

What is intubation?

Intubation is a process where a healthcare provider inserts a tube through a person’s mouth or nose, then down into their trachea (airway/windpipe).

The tube keeps the trachea open so that air can get through.

The tube can connect to a machine that delivers air or oxygen.

Intubation is also called tracheal intubation or endotracheal intubation.

Why would a person need to be intubated?

Intubation is necessary when your airway is blocked or damaged or you can’t breathe spontaneously.

Some common conditions that can lead to intubation include:

Airway obstruction (something caught in the airway, blocking the flow of air).
Cardiac arrest (sudden loss of heart function).
Injury or trauma to your neck, abdomen or chest that affects the airway.
Loss of consciousness or a low level of consciousness, which can make a person lose control of the airway.
Need for surgery that will make you unable to breathe on your own.
Respiratory (breathing) failure or apnea (a temporary stop in breathing).
Risk for aspiration (breathing in an object or substance such as food, vomit or blood).
What’s the difference between being intubated and being on a ventilator?
Being intubated and being on a ventilator are related, but they’re not exactly the same.

Intubation is the process of inserting an endotracheal tube (ETT) into the airway (windpipe)

The tube is then hooked up to a device that delivers air.

The device can be a bag that a healthcare provider squeezes to push air into your body, or the device can be a ventilator, which is a machine that blows oxygen into your airway and lungs.

Sometimes a ventilator delivers air through a mask, not a tube.

Who should not be intubated?

In some cases, healthcare providers may decide that it’s not safe to intubate, such as when there is severe trauma to the airway or an obstruction that blocks safe placement of the tube.

In such cases, healthcare providers may decide to open the airway surgically through your throat at the bottom of your neck.

This is known as tracheostomy.

When you have an endotracheal tube in place for more than a few days or are expected to have it for weeks, a tracheostomy is often necessary.

What happens during endotracheal intubation?

Most intubation procedures happen in the hospital. Sometimes emergency medical services (EMS) personnel intubate people outside the hospital setting.

During the procedure, healthcare providers will:

Insert an IV needle into your arm.
Deliver medications through the IV to put you to sleep and prevent pain during the procedure (anesthesia).
Place an oxygen mask over your nose and mouth to give your body a little extra oxygen.
Remove the mask.
Tilt your head back and insert a laryngoscope into your mouth (or sometimes your nose when necessary). The tool has a handle, lights and a dull blade, which help the healthcare provider guide the tracheal tube.
Move the tool toward the back of your mouth, avoiding your teeth.
Raise the epiglottis, a flap of tissue that hangs in the back of the mouth to protect your larynx (voice box).
Advance the tip of the laryngoscope into your larynx and then into your trachea.
Inflate a small balloon around the endotracheal tube to make sure it stays in place in the trachea and all air given through the tube reaches the lungs.
Remove the laryngoscope.
Place tape on the side of your mouth or a strap around your head to keep the tracheal tube in place.
Test to make sure the tube is in the right place. This can be done by taking an X-ray or by squeezing air through a bag into the tube and listening for breath sounds.

Can a person talk or eat when intubated?

The endotracheal tube passes through the vocal cords, so you won’t be able to speak.

Also, you cannot swallow when intubated, so you can’t eat or drink.

Depending on how long you’ll be intubated, your healthcare providers may give you nutrition through an IV or IV fluids or through a separate slim tube inserted in your mouth or nose and ending in your stomach or small bowel.

How is the tracheal tube removed during extubation?

When the healthcare providers decide it is safe to remove the tube, they will remove it.

This is a simple process called extubation.

They will:

Remove the tape or strap holding the tube in place.
Use a suction device to remove any debris in the airway.
Deflate the balloon inside your trachea.
Tell you to take a deep breath, then cough or exhale while they pull out the tube.
Your throat might be sore for a few days after extubation, and you might have a bit of trouble speaking.

What are the risks of intubation?

Intubation is a common and generally safe procedure that can help save a person’s life.

Most people recover from it in a few hours or days, but some rare complications can occur:

Aspiration: When a person is intubated, they may inhale vomit, blood or other fluids.
Endobronchial intubation: The tracheal tube may go down one of two bronchi, a pair of tubes that connect your trachea to your lung. This is also called mainstem intubation.
Esophageal intubation: If the tube enters your esophagus (food tube) instead of your trachea, it can result in brain damage or even death if not recognized soon enough.
Failure to secure the airway: When intubation doesn’t work, healthcare providers may not be able to treat the person.
Infections: People who’ve been intubated may develop infections, such as sinus infections.
Injury: The procedure can potentially injure your mouth, teeth, tongue, vocal cords or airway. The injury may lead to bleeding or swelling.
Problems coming out of anesthesia: Most people recover from anesthesia well, but some have trouble waking or have medical emergencies.
Tension pneumothorax: When air gets trapped in your chest cavity, this can cause your lungs to collapse.

Endotracheal intubation is a medical procedure that can help save a life when someone can’t breathe.

The tube keeps the trachea open so air can get to the lungs.

Intubation is usually performed in a hospital during an emergency or before surgery.

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