Everything You Need to Know About Endotracheal Intubation
If you’re a fan of Grey’s Anatomy, you might’ve seen a few scenes that include doctor inserting a tube into a patient’s mouth. Discover everything you need to know about Endotracheal Intubation: from how the procedure works to the possible side effects it may bring.
17 January 2019
If you’re a fan of Grey’s Anatomy, you might’ve seen a few scenes that include doctor inserting a tube into a patient’s mouth. Doctors often perform this procedure before surgery, or in an emergency, to give medicine or help a person breathe.

Discover everything you need to know about Endotracheal Intubation: from how the procedure works to the possible side effects it may bring.

What is endotracheal intubation?

Endotracheal Intubation (EI) is often an emergency procedure that is performed on people who are unconscious or who cannot breathe on their own. A flexible plastic tube, called an endotracheal tube (ET) is inserted into the windpipe (trachea) through the mouth or nose. The size of the ET is matched with our age and throat size. The tube is kept in place by a small cuff of air that inflates around the tube after it is inserted.

The tube is then connected to a ventilator, which pushes air into the lungs to deliver oxygen to the patient. EI keeps your airway open. This allows oxygen to pass freely to and from your lungs as you breathe.

Why is it done?

Endotracheal Intubation is done to:
  • Open the airway to give oxygen, medicine, or anesthesia.
  • Support breathing in certain illnesses, such as pneumonia, emphysema, heart failure, collapsed lung or severe trauma.
  • Remove blockages from the airway.
  • Allow the provider to get a better view of the upper airway.
  • It also helps to protect lungs in people who are unable to protect their airway and are at risk for breathing in fluid (aspiration). This includes people with certain types of stroke, overdoses, or massive bleeding from the esophagus or stomach.

How is it done?

The intubation procedure will vary depending on its purpose and whether it occurs in an operating room or in an emergency.

In the operating room or another controlled setting, the patient is typically sedated or unconscious due to illness or injury, which allows the mouth and airway to relax. The patient is laid flat on their back and the person inserting the tube is standing at the head of the table, looking at the patient’s feet.

The patient’s mouth is gently opened using a lighted instrument called laryngoscope. This instrument is used to keep the tongue out of the way and to locate sensitive tissues, such as the vocal cords, to avoid damaging them. If the doctor is having trouble seeing, a tiny camera may be inserted to give a more detailed view of the airway.

There is a small balloon around the tube that is inflated to hold the tube in place and to keep air from escaping. Once the balloon is inflated, the tube is securely positioned in the airway and it is tied or taped  at the mouth.

Once they have inserted the tube, the doctor will listen to the person’s breathing through a stethoscope to make sure that the tube is correctly placed. When the person no longer has difficulty breathing, the tube will be removed. During surgical procedures and in the intensive care unit, the tube is connected to a ventilator, or breathing machine, once it’s in the proper place.

In emergency, a paramedic may need to perform intubation to save a person’s life. Emergency intubation can have some risks. Some research indicates that emergency tracheal intubation can be risky because of the high-pressure environment and the fact that the individual may not be as stable as a person in an operating room.

Are there any risks of intubation?

Although intubation is low risk, there are some potential issues that can arise particularly when a patient must remain on the ventilator for an extended period of time. Common risks include:
  • Trauma to the voice box (larynx), thyroid gland, vocal cords and trachea, or esophagus
  • Accidental intubation in the esophagus instead of the trachea
  • Bleeding
  • Infection
  • Inability to be weaned from the ventilator, requiring tracheostomy
  • Aspirating (inhaling) vomit, saliva or other fluids while intubated
  • Pneumonia, if aspiration occurs
  • Sore throat
  • Hoarseness
  • Erosion of soft tissue (with prolonged intubation)
  • Puncture or tearing of body parts in the chest cavity, leading to lung collapse

Complications are more likely to occur if a doctor performs intubation in an emergency. The medical team will assess and be aware of these potential risks and do what they can to address them. However, it is vital to remember that intubation can be a life-saving procedure in these cases.

You may have a mild sore throat or some difficulty swallowing after the procedure, but this should go away quickly. There is also a slight risk that you will experience complications from the procedure. Make sure you call your doctor right away if you’re showing any of the following symptoms:
  • facial swelling
  • difficulty breathing
  • a severe sore throat
  • chest pain
  • difficulty swallowing or speaking
  • neck pain
  • shortness of breath

These symptoms may be a sign of other issues with your airway.

When is intubation necessary?

Intubation is required when general anesthesia is given. The anesthesia drugs paralyze the muscles of the body, including the diaphragm, which makes it impossible to take a breath without a ventilator.
Most patients are extubated, meaning the breathing tube is removed, immediately after surgery. If the patient is very ill or having difficulty breathing on their own, they may remain on the ventilator for a longer period of time.

Intubation is also performed for respiratory failure. There are many reasons why a patient may be too ill to breathe well enough on their own. They may have an injury to the lungs, they might have severe pneumonia, or a breathing problem such as COPD. If a patient cannot take in enough oxygen on their own, a ventilator may be necessary until they are once again strong enough to breathe without assistance.

Intubation is a common procedure that can be the difference between life and death in an emergency. In most cases, a person will fully recover from intubation within a few hours to days and will have no long-term complications. People can ask the doctor or surgeon about potential side effects and risks of intubation before surgery. If a person experiences any severe or unusual side effects, they should speak to a doctor right away.

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