What is endotracheal intubation?

Endotracheal intubation is a procedure to administer mechanical ventilation through a tube inserted in the airway.
Endotracheal intubation is a procedure to administer mechanical ventilation through a tube inserted in the airway.

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.

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Is endotracheal intubation used for COVID-19 coronavirus patients?

Endotracheal intubation is the approved way of providing breathing support to COVID-19 coronavirus disease patients as of this article's update in early April, 2020. 

Non-invasive mechanical ventilation like CPAP (continuous positive airway pressure) machines used for sleep apnea are not good for COVID-19 patients, according to clinical guidelines from the American Society of Anesthesiologists. In some cases, CPAP masks or nasal pillows may provide adequate oxygen, but current devices aerosolize virus particles in the patient's breath and spread them around wherever the patient is housed, potentially infecting more people in the area.

Endotracheal intubation and ventilation supports a COVID-19 patient's breathing so the body can survive as the immune system fights the virus. This means a better chance of fighting off the virus, but ventilators can't cure COVID-19.

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.

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Medically Reviewed on 4/1/2020
References
"Direct laryngoscopy and tracheal intubation in adults." UptoDate. Updated Aug 23, 2016.

American Society of Anesthesiologists COVID-19 Clinical Guidelines

February, 2020
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