Endotracheal intubation (EI) is an emergency procedure most often performed in patients who are unconscious or who cannot breathe on their own. EI helps to prevent suffocation or obstruction of the passage of air.
In a typical EI, a patient is first given a heavy anesthetic. Then, a flexible plastic tube is placed into the trachea (windpipe) through the mouth or sometimes the nose to help the patient with breathing.
The trachea, also known as the windpipe, is a cylindrical tube that is about four inches long and one inch in diameter.
It begins just under the voice box, descends behind the breastbone, and then divides into two smaller tubes. Each tube connects to one of your lungs.
The windpipe is made from discs of tough cartilage, muscle, and connective tissue. Its lining is composed of smooth tissue. Each time you breathe in, the windpipe gets slightly longer and wider—then returns to its normal size as you breathe out.
What kind of tube is used?
The tube that is used today is usually a flexible plastic tube. It is called an endotracheal tube because it is slipped within the trachea.
How do they put the tube down into the trachea?
The doctor often inserts the tube with the help of a laryngoscope, an instrument that permits the doctor to see the upper portion of the trachea, just below the vocal cords.
During the procedure the laryngoscope is used to hold the tongue aside while inserting the tube into the trachea. It is important that the head be positioned in the appropriate manner to allow for proper visualization.
Pressure is often applied to the thyroid cartilage (Adam’s apple) to help with visualization and prevent possible aspiration of stomach contents.
Where and How Is the Procedure Administered?
EI is typically performed in the hospital, where you will be given a strong sedative. In emergency situations, EI may be administered by a paramedic at the scene of the emergency.
Studies have shown that paramedics can successfully perform this procedure. (Gray, Cartlidge, & Gavalas, 1992).
In a standard EI surgery, you will receive an anesthetic before the procedure. Once you are sedated, an anesthesiologist will open your mouth and insert a small camera called a laryngoscope. This camera is used to examine the inside of the voice box.
Once the vocal cords have been located, the flexible plastic EI tube will be placed into your mouth and lowered through the vocal cords.
The tube may then be connected to a ventilator (breathing machine) or may be manipulated manually by attaching a bag to the tube, which the anesthesiologist will use to pump air into your lungs.
The anesthesiologist will then listen to your breathing through a stethoscope to ensure that the tube is in the right place. Once you no longer need help breathing, the tube is removed.
What is the purpose of endotracheal intubation?
The endotracheal tube serves as an open passage through the upper airway. The purpose of endotracheal intubation is to permit air to pass freely to and from the lungs in order to ventilate the lungs.
Endotracheal tubes can be connected to ventilator machines to provide artificial respiration. This can help when a patient is unconscious and by maintaining a patent airway, especially during surgery.
It is often used when patients are critically ill and cannot maintain adequate respiratory function to meet their needs. The endotracheal tube facilitates the use of a mechanical ventilator in these critical situations.
What are the Risks of the Procedure?
In most cases where EI must be performed, the patient will be under general anesthesia. Though most healthy people do not have any problems with general anesthesia, there is a small risk of long-term complications and, very rarely, death.
These risks largely depend upon your general health and the type of procedure you are undergoing.
Factors that may increase your risk of complications include:
- medical conditions that involve your lungs, kidneys, or heart
- family history of adverse reactions to anesthesia
- sleep apnea
- allergies to food or medications
- alcohol use
If you have any of these medical problems or are older, you may be more at risk of the following complications. However, these complications are still rare:
- heart attack
- lung infection
- temporary mental confusion
Waking Up While Under Anesthesia
According to the Mayo Clinic, about one or two people in every 1,000 wake up briefly while under the effects of general anesthesia (Mayo, 2010).
If this happens, usually you will be aware of your surroundings but will feel no pain. On rare occasions, people feel severe pain.
This can lead to long-term psychological problems. Factors that may increase the risk of this happening include:
- emergency surgery
- heart or lung problems
- long-term use of opiates, tranquilizers, or cocaine
- daily alcohol use
There are some risks related to intubation. To prevent these from occurring, you will be evaluated by the anesthesiologist (or ambulance personnel in an emergency situation) before the procedure and will be monitored throughout for potential complications such as:
- buildup of excess water in your tissues
- collapsed lung
Preparation for the Procedure
Intubation is an invasive procedure and can cause considerable discomfort. For this reason, general anesthesia and a muscle relaxing medication are usually administered so that you do not feel anything.
However, if necessary, the procedure can be performed while the patient is awake, with local anesthesia or with no anesthesia at all.
What are the complications of endotracheal intubation?
If the tube is inadvertently placed in the esophagus (right behind the trachea), adequate respirations will not occur. Brain damage, cardiac arrest, and death can occur.
Aspiration of stomach contents can result in pneumonia and ARDS. Placement of the tube too deep can result in only one lung being ventilated and can result in a pneumothorax as well as inadequate ventilation.
During endotracheal tube placement, damage can also occur to the teeth, the soft tissues in the back of the throat, as well as the vocal cords.
This procedure should be performed by a physician with experience in intubation. In the vast majority of cases of intubation, no significant complications occur.