What is endotracheal intubation?
Endotracheal intubation is the procedure to insert a flexible tube into the airway (trachea) through the mouth or the nose. The endotracheal tube is most often placed through the mouth, especially in emergencies. Endotracheal intubation is usually performed prior to surgeries with general anesthesia or in patients under critical care.
Is sedation required for intubation?
Intubation procedure can cause discomfort, stress and pain for patients, so sedation and painkillers (analgesics) are usually mandatory during intubation. A rapid-acting, short-duration sedative is administered along with other medications to block pain and reflex actions like gagging.
What anatomical landmark is used for tracheal intubation?
The tip of the epiglottis is the anatomical landmark doctors look for when performing tracheal intubation. The epiglottis is a flap of cartilage located below the root of the tongue, on top of the voice box (larynx). The epiglottis covers the tracheal opening while swallowing food or drink to prevent them from getting into the trachea. The epiglottis remains open at other times to allow breathing.
What is endotracheal intubation used for?
Endotracheal intubation may be performed for the following reasons:
- Keeping the airway open and preventing inhalation of gastric contents (aspiration) during surgeries with general anesthesia
- Providing a pure oxygen supply to the lungs (as opposed to the mixed-gas ratios in the general atmosphere)
- Administration of anesthesia and certain medications
- Clearing blockage in the airway
- Supporting breathing in critically ill patients who are unable to breathe or have difficulty breathing because of illness or trauma
- Many people with severe COVID-19, the respiratory conditions caused by the pandemic coronavirus, must spend weeks intubated and receiving oxygen via ventilation machines.
How is endotracheal intubation done?
Endotracheal intubation before a planned surgery may be performed with sedation alone. Patients should fast in preparation to reduce the risk of vomiting and aspiration.
Mechanical ventilation with an oxygen mask (bag-valve-mask) is started before anesthesia and paralysis are induced.
When endotracheal intubation is performed in an emergency, preparatory fasting is not possible. A protocol known as rapid sequence intubation is followed, which induces unconsciousness and paralysis rapidly.
Bag-valve-mask ventilation is avoided after induction of anesthesia and paralysis, in order to prevent aspiration and stomach insufflation (filling with air).
Mechanical ventilation starts only after completion of the intubation procedure.
Rapid sequence intubation is not performed if the patient is already unconscious or not breathing. The patient is intubated with immediate bag-valve-mask ventilation.
An anesthetic team performs the tracheal intubation, coordinating with the physician/surgeon and nurse. The intubation steps are as follows:
- Administer anesthesia and muscle relaxant.
- Apply pressure on the cricoid cartilage located in the throat to block the esophagus and prevent the tube’s entry into it.
- Use a laryngoscope to see the epiglottis and the opening to the trachea.
- Gently insert the tube into the trachea and secure the tube in place.
Rapid sequence intubation involves administration of specific medications in three stages before the tube insertion.
Stage 1: Pretreatment
Preoxygenation is performed to maximize the oxygen saturation levels in the blood and create an oxygen reservoir in the lungs. Preoxygenation provides continued oxygen for circulation for the duration of intubation procedure, when the patient remains in a state of anesthetic paralysis and cannot breathe for themselves.
Preoxygenation is accomplished by delivering high-flow oxygen for three minutes using a face mask. Nitrogen constitutes about 80% of ambient air in the general atmosphere. Preoxygenation replaces the nitrogen in the lung’s air sacs (alveoli) with oxygen.
Preoxygenation allows eight minutes to complete tracheal intubation before the oxygen blood saturation starts to fall below 90%. Oxygen desaturation may be more rapid in children and acutely ill patients with respiratory problems. If oxygen saturation falls below 90%, start bag-valve-mask ventilation.
Premedication involves preventive administration of medications two to three minutes prior to intubation to prevent pain (analgesia) and control physiological responses induced by the insertion of the laryngoscope into the airway.
Intubation can induce:
- Pressor response: Pressor response is the sympathetic nervous system’s reflex to the insertion of laryngoscope. The laryngoscope’s edge stimulates the pharynx, larynx and the trachea, inducing stress response and release of stress hormones, which leads to elevation of blood pressure and heart rate. The pressor effects may last for about five minutes, and may be unsafe for critically ill patients.
- Intracranial hypertension: Intracranial hypertension is elevated pressure in the cerebrospinal fluid around the brain, which can result in cerebral edema or reduced blood supply (ischemia) to the brain. In addition to the pressor response the laryngoscope causes reflexes such as coughing and gagging, which together can lead to transient intracranial hypertension.
Stage 2: Induction
The induction phase of intubation involves the administration of an anesthetic agent. A rapid-acting, short duration sedative is administered intravenously to induce unconsciousness and unresponsiveness.
Stage 3: Paralysis
The final step before tracheal intubation is to induce temporary paralysis in the muscles to prevent them from contracting and hindering the procedure. After the induction of anesthesia, a paralytic agent is used to relax the skeletal muscles.
The motor function of the muscles is controlled by the brain through transmission of signals through the nerves. The nerve endings, where they join with the muscles, release a neurotransmitter known as acetylcholine which activates the muscles.
Paralytic medications are neuromuscular blockade agents which interfere with acetylcholine’s activity and prevent muscular activation. Paralytic agents prevent gagging and coughing reflexes during intubation.
Health Solutions From Our Sponsors
Top What Is Endotracheal Intubation Used For Related Articles
Respiratory Illnesses: 13 Types of Lung InfectionsIs your cough caused by a cold, flu, pneumonia or something else? Learn causes of respiratory infection like bronchitis, pneumonia, SARS, Coronavirus COVID-19 bird flu, and more.
COPD Lung SymptomsCOPD is a pulmonary disorder caused by obstructions in the airways of the lungs leading to breathing problems. Learn about COPD symptoms, diagnosis, and treatment options.
EmphysemaEmphysema is a COPD (chronic obstructive pulmonary disease) that often occurs with other obstructive pulmonary problems and chronic bronchitis. Causes of emphysema include chronic cigarette smoking, exposure to secondhand smoke, air pollution, and in the underdeveloped parts of the world. Symptoms of emphysema include chronic cough, chest discomfort, breathlessness, and wheezing. Treatments include medication and lifestyle changes.
How Long Does Lung Cancer Take to Develop?The time taken for lung cancer to develop is variable. It takes several years for cancer to develop in the lungs. Early lung cancer does not alert obvious physical changes. Moreover, patients can live with lung cancer for many years before they show any signs or symptoms.
How Serious Is a Blood Clot in the Lungs?A blood clot is a solid or semisolid clump of blood. When the tissues of our body are injured, excessive blood loss is prevented by the clotting of blood. When a blood clot occurs inside the blood vessels it may lead to serious medical conditions. When a blood clot occurs inside the arteries to the lungs, the condition is called pulmonary embolism (PE).
Lung CancerLung cancer kills more men and women than any other form of cancer. Eight out of 10 lung cancers are due to tobacco smoke. Lung cancers are classified as either small-cell or non-small-cell lung cancers.
Lung Cancer SlideshowLearn about lung cancer early warning signs, symptoms and treatments. What causes stage IV lung cancer? Get more information on small cell lung cancer, non-small cell lung cancer, and the diagnosis of lung cancer stages.
Know Your Lung Cancer Facts QuizLung cancer is the number one cause of cancer deaths in both men and women in the U.S. and worldwide. Get the facts about lung cancer with this quiz.
Reasons You're Short of BreathHave you ever found yourself gasping for air after just a short flight of stairs? You may just need to do a bit more exercise, or it could be something more serious.
What Are Lung Segmentectomy and Limited Pulmonary Resection?A lung segmentectomy is a procedure to remove the diseased lung without removing excess normal lung. Lung segmentectomy and limited pulmonary resection are performed due to bonchiectasis, early-stage lung cancer, lung nodules, tuberculosis, and suppurative lesions. Complications include air leakage, bleeding, residual airspace, infection of the pleural space, respiratory failure, and cardiac complications.
Lungs PictureThe lungs are a pair of spongy, air-filled organs located on either side of the chest (thorax). See a picture of the Lungs and learn more about the health topic.
Pulmonary Embolism (Blood Clot in the Lung)A pulmonary embolism (PE) occurs when a piece of a blood clot from deep vein thrombosis (DVT) breaks off and travels to an artery in the lung where it blocks the artery and damages the lung. The most common symptoms of a pulmonary embolism are shortness of breath, chest pain, and a rapid heart rate. Causes of pulmonary embolism include prolonged immobilization, certain medications, smoking, cancer, pregnancy, and surgery. Pulmonary embolism can cause death if not treated promptly.
Smoker's Lung: Pathology Photo EssaySmoker's lung photo essay is a collection of pictures and microscopic slides of lung disease caused by cigarette smoking. Smoker's lung refers to the diseases and structural abnormalities in the lung caused by cigarette smoking.
What Is Usually the First Sign of Lung Cancer?Most often, lung cancer does not show any signs and symptoms until it has advanced to higher stages when it becomes difficult to treat. The initial signs and symptoms vary among patients but may include cough that remains unrelieved and gets worse over time, hemoptysis (coughing up blood) or reddish spit, chest pain that worsens on breathing or laughing, hoarseness of voice, weight loss, persistent chest pain, and frequent lung infections.
Why Would A Child Need A Tracheostomy?A tracheostomy, a procedure to cut a hole in the throat to clear an airway to the lungs, is used to insert a tube into the trachea to provide assisted ventilation to children who are unable to breathe, or have difficulty breathing on their own.
Will a Chest X-Ray Show Lung Cancer?When diagnosing lung cancer, chest X-rays do not provide a definitive diagnosis of lung cancers at an early stage (when they are more treatable). Until the lung cancer shows up on a chest X-ray, the tumor is often too far advanced to be cured. Often, many things seen on a chest X-ray turn out to be treatable problems or artifacts.