Intubation – indications, procedure, consequences

Proven content

Intubation is the placement of a plastic tube into the trachea to open the airway. The trachea is the organ responsible for the movement of air to the lungs. Tube intubation is called endotracheal intubation. The endotracheal tube is placed in the trachea by inserting it through the oral cavity. In exceptional circumstances, when there is no other access, the tracheal tube is placed in the trachea through the nose. Intubation is a procedure that is performed not only during elective surgery, but also in the event of an emergency.

Intubation – what is it?

Tracheal intubation involves placing a plastic tube in the trachea – the purpose of the procedure is to open the airway. Properly placed tube protects the patient against aspiration with food. The device is designed to ensure proper lung ventilation with the use of a respirator or a self-inflating bag. Intubation is performed by an anesthesiologist or paramedic.

Tracheal intubation is a difficult procedure. It cannot always be performed in the pre-hospital setting. Unlike epiglotting methods, the procedure takes longer and is risky. The procedure should always be performed by a qualified person with extensive experience in intubating patients.

Patient intubation – indications

The indications for endotracheal intubation of the patient are:

1. Respiratory protection – this procedure is performed in the event of acute respiratory failure. The patient must be intubated to prevent aspiration of blood or stomach contents. Tracheal intubation is also performed when oxygenation is not possible with a face mask.
2. Conducting resuscitation – fixing the tracheal tube restores the proper pumping of air to the lungs. Tracheal intubation should be performed while the patient is unconscious or not breathing. This method is used in life-threatening cases.
3. Administration of an anesthetic – the procedure is also performed when it is necessary to use a muscle relaxant. The indication for the procedure is the patient’s participation in the operation under general anesthesia, which requires mechanical ventilation.

Oral and nose intubation

There are two ways of intubation – through the mouth or through the nose. Necessary equipment is an endotracheal tube and a laryngoscope. Occasionally, the anesthetist may use a guide, oropharyngeal tube, and a special grip. Oral intubation is the most common method of choice in most cases. The size of the tracheal tube must always be appropriate to the age, sex and build of the patient.

Oral intubation is the placement of a tube in the windpipe between the vocal cords. The end of the tube is placed over the bifurcation of the trachea and this is always a well-defined location. Intubation through the nose involves inserting the tube into the nasopharynx – when the end of the tube is visible in the throat, the doctor uses a laryngoscope.

Both methods are not interchangeable. Oral intubation is primarily used when treating adults. In turn, nasal intubation is used to treat newborns and people after oropharyngeal surgery. These techniques also differ in the type of accessories used – nasal intubation uses longer and narrower tubes, more curved than those for oral intubation.

Intubation – other methods

Rapid intubation is usually used when the placement of an endotracheal tube may allow gastric contents to enter the respiratory system. Obese people, pregnant women, people with gastrointestinal obstruction, and people with a full stomach are at risk. It is also used when the patient is to be operated suddenly.

Retrograde intubation is a procedure that involves puncturing the skin, subcutaneous tissue and the cricothyroid ligament. As a result, an opening is created through which the guide can be inserted into the larynx. The device is directed towards the oral cavity and places an endotracheal tube thereon. Unlike oral intubation, it does not require the use of a laryngoscope. When the patient is intubated, the doctor removes the guide.

Intubation – step by step

The patient’s head must be tilted back during the procedure to help the clinician guide the tube. The endotracheal tube is inserted using a laryngoscope – the laryngoscope is used to illuminate the oral cavity and keep the tongue in a stable position. During the procedure, the doctor inserts the tube with one hand, using a laryngoscope set at a 45-degree angle. This allows the tube to enter the trachea. Once there, the doctor removes the laryngoscope and attaches a ventilator or manual resuscitator to the tube.

Intubation – complications

Intubation, like any medical procedure, carries the risk of complications. The most common complications are:

1. sore throat,
2. cough,
3. hoarseness,
4. difficulty swallowing saliva
5. dentition damage,
6. degenerative changes in the larynx,
7. adhesions,
8. strictures.

To avoid health complications, the doctor checks the position of the tube after the procedure. In addition to the above-mentioned risks, it is worth mentioning that there is also a risk of puncture and damage to the vocal cords – however, these are rare cases, resulting from particularly unfavorable anatomical conditions. Mucosal bleeding may occur during nasal intubation

Exstubation – what is it?

This is the act of removing the tracheal tube from the trachea. However, before this happens, the patient must breathe independently, respond to commands and have a cough reflex. Before the tube is removed from the trachea, the patient receives oxygen. The doctor also monitors blood oxygen saturation. Extubation also carries some risk of complications.