Placing a tube into the trachea to keep the airway open and support breathing. The procedure is performed in emergency and intensive care settings.
Indication
- Respiratory failure or severe respiratory distress
- Decreased consciousness (Glasgow Coma Scale ≤ 8) and inability to protect the airway
- Airway threat from severe trauma, burns, or facial/neck swelling
- Surgical procedures requiring general anesthesia
- Resuscitation following cardiac or respiratory arrest
- Airway protection in patients at high risk of aspiration
Preparation
- Equipment check: laryngoscope, appropriately sized tube (typically 7-8 mm internal diameter in adults), suction, bag-mask
- IV access and monitoring (ECG, SpO2, blood pressure, capnography) are established
- Preoxygenation: lungs are filled with 100% oxygen for at least 3 minutes
- In a rapid sequence intubation (RSI) protocol, sedative and paralytic medications are prepared
How it's performed
- The patient is positioned appropriately, with the head slightly tilted back (sniffing position)
- If RSI is used, a sedative (etomidate, ketamine, propofol, etc.) is followed by a paralytic (succinylcholine, rocuronium)
- The vocal cords are visualized with a laryngoscope, and an appropriately sized endotracheal tube is passed through the cords into the trachea
- The cuff is inflated to prevent air leak; the tube is connected to a ventilator or bag
- Correct tube placement is confirmed with capnography (ETCO2), chest movement, lung auscultation, and chest X-ray
- The tube is secured, and sedation and analgesia are continued as needed
Post-procedure
- Continuous SpO2, capnography, and ventilator parameter monitoring
- Tube position and cuff pressure are checked regularly
- Aspiration and infection prevention measures are applied
- Sedation targets are reassessed at every shift
- Daily evaluation for extubation (removing the tube) as soon as safely possible
Risks
- Injury to teeth, lips, or vocal cords
- Esophageal misplacement or migration into a single bronchus
- Aspiration, laryngeal edema, or hoarseness
- Drop in blood pressure, arrhythmias
- Ventilator-associated pneumonia
FAQ
Is intubation painful?
Appropriate sedative and analgesic medications are administered during the procedure; because the patient is not conscious, pain is not felt.
How long does the tube stay in?
It depends on the underlying condition. It can range from a few hours to several weeks. Tracheostomy may be considered when intubation is needed for a long period.
Are speech and swallowing affected afterward?
Temporary hoarseness and sore throat are common and usually improve within a few days; permanent problems are rare.
When does the patient wake up after intubation?
Once sedation is stopped and the patient can sustain breathing, the tube is removed; the timing varies with the clinical situation.
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