What is Intubation? In Which Situations and Why is Intubation Performed?

Intubation is a procedure that can help save lives when someone cannot breathe. Intubation is also called tracheal intubation or endotracheal intubation. A healthcare professional uses a laryngoscope to guide the endotracheal tube (ETT) into the mouth and nose, into the voice box, and then into the trachea. The tube keeps the airway open so air can reach the lungs. As a result of this process, the aim is to start breathing that is interrupted or absent and becomes regular. Intubation is usually done in emergency situations or in the hospital before surgery. In very emergency situations, intubation, especially through the mouth, saves lives.

What is Intubation?

Intubation is the process of placing a tube called an endotracheal tube (ET) into the mouth or nose and then into the airway (trachea) and keeping it open. Once in place, the tube is connected to a machine called a ventilator (or a compressed bag if inaccessible) to push air in and out of the lungs. Mostly for a short period of time
release
is performed and the person does not go home when intubated. Patients cannot be discharged by intubation and must be under medical supervision. If there is a situation that makes breathing difficult, it is necessary to connect to a respirator. Ventilator support will be turned off as breathing improves and support is no longer needed.

Why is Intubation Done?

Intubation may occur for many reasons. Doctors use intubation as part of intensive care and in anesthesiology. It also keeps the airway open during intubation and surgery performed under general anesthesia. This is necessary because general anesthesia suppresses breathing and other automatic body functions.

People may need to be intubated if they have respiratory failure or cannot breathe well on their own. Doctors connect the tube to a ventilator to perform intubation. Intubation steps are carried out sequentially and breathing is regulated.

In what cases is intubation performed?

Intubation is necessary when the airway is blocked, damaged, or when spontaneous breathing is not possible. Some common situations that may lead to intubation include:

• Airway obstruction: Intubation may be performed when any object stuck in the respiratory tract blocks airflow.
• Cardiac arrest: In cases of sudden loss of heart function, the patient may not be able to breathe adequately. In this case, intubation is performed.
• Injury or trauma affecting the airway in the neck, abdomen, and chest
• Loss of consciousness or low level of consciousness: Loss of consciousness or low level of consciousness that may cause the person to lose control of the airway may require intubation. With intubation, the person’s airways are kept open and air is allowed in.
• A surgery that will cause the person to be unable to breathe on his own: In a surgical operation under the influence of anesthesia, breathing can be controlled by intubation.
• It is preferred in cases such as respiratory failure or apnea (temporary cessation of breathing).
• Aspiration risk: Inhaling an object or substance such as food, vomit, or blood may cause respiratory irregularities, requiring intubation.

How is Intubation Performed?

Tracheostomy procedures are performed when there is obstruction in the airway and intubation is not medically possible, the patient has insufficient oxygen delivery or has a secretion problem. Intubation is possible with two different methods. These methods are as follows.

Endotracheal Intubation (Intubation through the mouth): It is intubation through the mouth. Since it is generally faster than nasotracheal intubation, it is the preferred method, especially in emergency situations. The steps of endotracheal intubation are as follows:

• The person is laid flat on his back.
• The provider positions himself above the person’s head, facing their feet.
• The person’s mouth is opened and a guard can be worn to protect the teeth.
• With the help of a lighted tool that also keeps the tongue away, the provider gently guides the ET tube into the person’s throat and advances it into the airway.
• A small balloon at the end of the tube is inflated and fixed in place, preventing air from escaping.
• The tube outside the mouth is fixed with tape.
• The tube may then be connected to a ventilator or used to give anesthesia or medication.
• The provider will check that the placement of the tube is correct with a stethoscope, chest X-ray, and/or an instrument called a capnograph that detects carbon dioxide being expelled from the lungs.

Nasotracheal Intubation (Intubation through the nose): The process of nasotracheal intubation is similar to endotracheal intubation, but the person may be fully or partially sedated. This is intubation through the nose and into the trachea. Doctors often use this approach in people who are awake and breathing normally or in people who need to avoid using the mouth. Since nasal intubation is more often done in a controlled environment, there may be other tools involved in the process. For example, a provider may use 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. Nasotracheal Intubation is performed as follows;

• After the tube is fed into the nostril and enters the middle part of the throat, a fiberoptic microscope 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 windpipe
• The tube is taped to the outside to prevent it from moving.

What are the Risks of Intubation?

Intubation is a common and generally safe procedure that can help save a person’s life. Most people recover within a few hours or days, but some rare complications can occur:

• Aspiration: A person may inhale vomit, blood, or other fluids when intubated.
• Endobronchial intubation: The tracheal tube can go down into one of two bronchi, which are a pair of tubes that connect the trachea to the lung. This is also called main intubation.
• Esophageal intubation: If the tube goes into the esophagus (food tube) instead of the trachea, it can cause brain damage or even death if not noticed early enough.
• Failure to secure the airway: When intubation does not work, healthcare providers may not be able to treat the person.
• Infections: People who are intubated may develop infections, such as sinus infections.
• Injury: The procedure can potentially damage the mouth, teeth, tongue, vocal cords, or airway. The injury may cause bleeding or swelling.
• Problems from anesthesia: Most people recover well after anesthesia, but some have trouble waking up or experience medical emergencies.
• Tension pneumothorax: When air becomes trapped in the chest cavity, this can cause your lungs to collapse.