Definition & Overview
Endotracheal intubation, which is more commonly referred to as intubation, is a medical procedure wherein a flexible plastic tube is placed into the trachea to provide the patient with an open airway.
Endotracheal intubation is a primary airway management technique. It is safe, simple, and can be performed quickly in emergency situations. The procedure provides immediate breathing support for patients who are unable to breathe on their own. The tube can also be used to protect the lungs from aspiration and as a conduit by which drugs can be directly introduced.
Who Should Undergo and Expected Results
Endotracheal intubation is necessary for patients who are unable to breathe on their own. During the procedure, a tube is placed into the patient’s trachea.
The trachea is a 4-inch long and 1-inch wide tube that carries air to the lungs. It is made up of cartilage, muscle, and connective tissue, while its lining is made up of smooth tissue. If it is damaged or obstructed in any way, the patient will not be able to breathe.
The goals of an endotracheal intubation procedure include the following:
- To open the airway and provide oxygen, medicine, and anaesthesia
- To support the patient’s breathing in times of disease-related distress
- To provide doctors a better view of the upper airway
- To protect the lungs in patients who are at risk of fluid aspiration
The procedure is beneficial for patients who suffer from the following conditions:
- Respiratory arrest
- Respiratory failure
- Class III or IV haemorrhage
- Pulmonary contusion
- Collapsed lung
- Heart failure
- Massive bleeding from the oesophagus
- Intestinal or stomach bleeding
- Head injury
- Inhalation injury accompanied by erythema or oedema of the vocal cords
After endotracheal intubation, the patient’s airways become completely open. This allows oxygen to pass to and from the lungs freely.
How is the Procedure Performed?
Endotracheal intubation is an invasive procedure that is only performed when absolutely necessary. The procedure is performed through the following steps:
- The patient is placed under either local or general anaesthesia. A muscle relaxant is also provided.
- The doctor positions the patient’s head properly to make sure that he can properly view the inside of the throat.
- The doctor inserts a laryngoscope through the patient’s mouth to examine the larynx. This tube also helps hold the tongue while the procedure is being performed.
- The doctor monitors the patient’s vocal cords to make sure they will not be adversely affected. He also applies some pressure to the thyroid cartilage (Adam’s apple) to improve visualisation. Doing so also helps keep the patient from aspirating the contents of his stomach.
- The doctor then inserts a flexible plastic tube into the mouth and carefully lowers it down through the vocal cords.
- The tube is sometimes connected to a ventilator for patients who need oxygen support from a machine.
- Sometimes, however, it is attached to a bag that allows the doctor to pump air into the patient’s lungs.
- When the tube is in place, the doctor listens to the patient’s breathing to make sure it is correctly positioned.
- The tube can be safely removed once the patient is able to breathe on his own.
While endotracheal intubation is commonly performed in a hospital's operating room, the procedure is sometimes also performed by a paramedic at the scene of an emergency.
Possible Risks and Complications
Since the procedure is performed in emergency situations, it is often vital and life-saving. Thus, the risks involved are minimal compared to its potential benefits.
The risks of endotracheal intubation include:
- Allergic reaction to anaesthesia
- Collapsed lung
- Fluid buildup
- Inadequate ventilation
- Teeth damage
- Damage to the soft tissues at the back of the throat
- Damage to the vocal cords
- Failed intubation
- Oesophageal intubation
- Bronchial intubation
It is also normal for patients to experience some discomfort after the procedure due to having a tube in their necks.
A person’s risk of suffering from complications during and after the procedure depends on his general state of health and on whether the tube is placed properly or not. Patients who meet the following risk factors face an increased risk of complications.
- Heart, lung, and kidney diseases
- Family history of adverse reactions to anaesthesia
- Sleep apnoea
- Alcohol use
- Allergies to certain food or medications
Circumstances surrounding the procedure may also affect its outcome. Intubations conducted in a hurried manner are more likely to cause complications.
Despite these risks, the majority of intubation procedures are performed without complications.
If endotracheal intubation is not appropriate, doctors can use other alternatives to provide breathing support. These include:
- Oesophageal tracheal combitube (ETC)
- Laryngeal mask airway
However, these procedures also come with certain complications. Endotracheal intubation is considered as the standard procedure for the purpose of airway management.
Pepe PE, Copass MK, Joyce TH. “Prehospital endotracheal intubation: Rationale for training emergency medical personnel.” Annals of Emergency Medicine. 1985 Nov. 14(11): 1085-1092. http://www.sciencedirect.com/science/article/pii/S0196064485809276
Knealing MA. “Endotracheal intubation: Still the Gold Standard.” The Scholarly Journal of North Hennepin Community College. http://northernlightnhcc.org/?p=519