Endotracheal Intubation
Endotracheal intubation is a procedure that involves the placement of a flexible tube into the trachea (windpipe) to open the airways. The tube is most often inserted through the mouth during emergency situations, but it can also be inserted through the nose. Endotracheal intubation can help remove blockages and increase oxygen levels; it is also used to administer medication or anesthesia. Most often, it is performed to ventilate the lungs of critically ill patients.
Nasotracheal (through the nose) intubation, though far less common than orotracheal intubation (through the mouth), is typically performed on patients undergoing maxillofacial surgery or dental procedures when oral intubation is impossible, or on patients who have a limited capability of opening their mouths. At one time, nasotracheal intubation was commonly used in critical care units. It is now used on a much more limited basis because it is associated with complications that include nasal damage, sinusitis and regional abscesses.
Reasons for Endotracheal Intubation
There are several reasons, all of them serious, that endotracheal intubation may be necessary:
- Opening the air passages to administer oxygen
- Opening the air passages to administer medication or anesthesia
- Removing blockages from the airway
- Permitting a doctor to have a clear view of the upper airway
Intubation may also be performed to protect the lungs of unconscious patients who are unable to do so independently by coughing.
The Endotracheal Intubation Procedure
The majority of endotracheal intubations are performed on unconscious patients in emergency situations, or on patients who are under heavy sedation or anesthesia prior to surgery. A patient for whom anesthesia is too great a risk, and who must therefore be awake or semiconscious during the procedure, are administered anti-anxiety medications, as are patients who awaken while the endotracheal tube is still in place.
The doctor often uses a laryngoscope during the procedure in order to visualize the upper trachea. Pressure may be applied to the thyroid cartilage (Adam's apple) in order to improve visualization, and to prevent aspiration of stomach contents. During the intubation procedure, most patients are connected to a mechanical ventilator (breathing machine).
Risks of Endotracheal Intubation
Endotracheal intubation, like all surgical procedures, carries certain risks, such as those of excessive bleeding or infection. Risks specific to this particular procedure include trauma to adjacent body parts, including the following:
- Teeth, soft palate or throat tissue
- Larynx (voice box) or vocal cords
- Thyroid gland
- Trachea
- Esophagus
- Lungs
A serious complication occurs if the endotracheal tube is mistakenly inserted into the esophagus instead of the trachea. In such situations, not only will inadequate respiration result, but stomach contents can be aspirated, leading to aspiration pneumonia or acute respiratory distress syndrome (ARDS). There is also some danger if the tube is inserted too deeply and some part of the chest cavity is torn or punctured, resulting in lung collapse (pneumothorax).
In spite of the inherent risks of endotracheal intubation, when performed by a highly skilled physician, it is quite safe, with a low rate of complications.