Endotracheal Intubation
Revising Medical Author: George Schiffman, MD
Revising Medical Editor: Melissa Conrad Stöppler, MD
What is endotracheal intubation?
Endotracheal intubation is a procedure by which a tube is inserted through
the mouth down into the trachea (the large airway from the mouth to the lungs).
Before surgery, this is often done under deep sedation. In emergency situations,
the patient is often unconscious at the time of this procedure.
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.
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 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.
It is no wonder that this procedure should be performed by a physician with
experience in intubation. In the vast majority of cases of intubation, no
significant complications occur.
Last Editorial Review: 4/30/2007
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