What Is Intubation and Why Is It Done.. Table of Contents Purpose Risks Procedures Feeding During Intubation Tube Removal Intubation is the ...
What Is Intubation and Why Is It Done..
Intubation is the process of inserting a tube into the mouth or nose and then into the airway to help move air in and out of the lungs. There are several reasons why it may be performed, but it is mainly used to support breathing during surgery or an emergency.1
This article explains the different uses of intubation, how it is performed, and the risks involved.
Uses
When the tube is inserted through the mouth, it is referred to as endotracheal intubation
1.When it is inserted through the nose, it is known as nasotracheal intubation
2.There are a variety of different reasons someone may be intubated, and the method used depends on the purpose.
Endotracheal (through the mouth) intubation is used in most emergency situations. That's because the tube that gets placed through the mouth is larger and easier to insert than the one inserted through the nose.
Endotracheal intubation may be used to:1
- Keep the airway open to provide oxygen, medicine, or general anesthesia
- Support breathing in people with pneumonia, emphysema
- heart failure, collapsed lung, or severe trauma
- Remove a blockage from the airway
- Prevent fluid from entering the lungs due to stroke, overdose, or massive bleeding from the stomach
Nasotracheal (through the nose) intubation is used to:2
- Protect the airway if there is an impending threat of obstruction
- Deliver anesthesia for surgeries involving the mouth, head, or neck (including dental surgery)
Recap
Endotracheal intubation is typically used in emergencies. It also supports breathing in people with severe breathing problems due to disease or trauma. Nasotracheal intubation is more commonly used to deliver anesthesia, but it can also protect the airways if there is a risk of obstruction.
Risks
The benefits of intubation tend to outweigh any risks. Even so, there are some that should be considered, especially in people who are on a ventilator for a long period of time.
Common risks include:
- Gagging or choking
- Sore throat
- Hoarseness
- Bleeding
- A hole in the esophagus or soft palate
- Trauma to the teeth, mouth, sinuses, larynx (voice box), or trachea (windpipe)
- Bacterial infection, such as aspiration pneumonia
- Damage to soft tissues with prolonged use
- Inability to be weaned off a ventilator, requiring a surgical procedure to insert a tube directly into the windpipe to assist with breathing (tracheostomy)
Procedures
The process of intubation varies based on whether the tube is inserted into the mouth or nose. Adjustments are also made when children are involved.
Endotracheal Intubation
Prior to intubation, a person is typically sedated or unconscious due to trauma. The process follows the same basic steps:
- The person is laid flat on their back.
- The health provider positions themselves above the person's head looking down at their feet.
- The person's mouth is opened. A guard may be inserted to protect the teeth.
- With the help of a lighted instrument that also keeps the tongue out of the way, the tube is gently guided into the throat and advanced into the airway.
- A small balloon at the end of the tube is inflated to secure it in place and keep air from escaping.
- The tube on the outside of the mouth is secured with tape.
- The tube can then be connected to a ventilator or used to deliver anesthesia or medications.
- The healthcare provider will check that the placement is correct with a stethoscope, a chest X-ray, and/or a tool called a capnograph that detects carbon dioxide exhaled from the lungs.
Nasotracheal Intubation
The process of nasotracheal intubation is similar to endotracheal intubation, but the person may either be fully or partially sedated.
Since nasal intubation is more often performed in a controlled environment, there may be other tools involved in the process
This includes the use of a decongestant spray to prevent nosebleeds, a topical anesthetic to reduce pain, and a muscle relaxant to prevent gagging. Some providers will also widen the passage with a device called a nasal trumpet.
Once the tube is fed into the nostril and enters the middle part of the throat, a fiberoptic scope (called a laryngoscope) helps guide the tube between the vocal cords and into the windpipe. The tube is then inflated to secure it in the trachea and taped on the outside to keep it from moving.
Intubating Children
The process of intubation is more or less the same for adults and children, aside from the size of the tube and some of the equipment used.
Newborns can be especially difficult to intubate, not only because of their smaller size but because their tongues are proportionally larger and the passage into the windpipe is proportionately longer and less flexible. Nasal intubation is the preferred method for newborns and infants. Still, it can take several attempts to place the tube.
Recap
Intubation involves the insertion of a tube through the mouth or nose, which is then secured in the windpipe with an inflatable balloon. This can be done in both adults and children, although it may take several attempts in newborns.
Feeding During Intubation
If an intubated person needs to be on a ventilator for two or more days, tube feeding will typically start a day or two after the tube is inserted. This is referred to as enteral nutrition.
Because it isn't possible to take food or fluids by mouth while intubated, tube feeding may be delivered in one of two ways:8
Orogastric (OG): Using a tube that passes through the mouth and into the stomach
Nasogastric tube (NG): Using a tube that passes through a nostril and into the stomach
Medication, fluids, and nutrition can then be pushed through using a large syringe or pump.
For other people, nutrition may be given intravenously (via a needle in the arm). Also known as total parenteral nutrition (TPA), this is an option for people with severe malnutrition and weight loss, as well as those with a blockage in the intestine or diseases that make tube feeding impossible.8
When Feeding Tubes Are Needed Full Time
Tube Removal
Extubation is the process of removing a tracheal tube. When it is time to do so, the tape that holds the tube in place is removed.
Next, the balloon that holds the tube in the airway is deflated and the tube is gently pulled out.
Once the tube is out, you may have to work to breathe on your own, especially if you have been on a ventilator for a long time.
Coughing, hoarseness, and discomfort are common, but these tend to improve with a few days.4
Recap
Those on a ventilator for two or more days can receive nutrition and fluids through a tube that leads to the stomach. Everyone who is intubated will eventually have their tube removed. Some may simply be uncomfortable afterward; others may need to work on resuming breathing normally again.
Summary
Intubation is the insertion of a tube either through the mouth or nose and into the airway to aid with breathing, deliver anesthesia or medications, and bypass a blockage.
It is called endotracheal intubation when the tube is inserted into the mouth and a nasogastric tube when the tube is fed through a nostril. The procedure for both is largely the same. Once the tube is fed into the windpipe, a balloon at the end of the tube is inflated to secure its position and prevent air from escaping
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