Endotracheal intubation





Definition

Endotracheal intubation is the placement of a tube into the trachea (windpipe) in order to maintain an open airway in patients who are unconscious or unable to breathe on their own. Oxygen, anesthetics, or other gaseous medications can be delivered through the tube.


Purpose

Specifically, endotracheal intubation is used for the following conditions:

  • respiratory arrest
  • respiratory failure
  • airway obstruction
  • need for prolonged ventilatory support
  • Class III or IV hemorrhage with poor perfusion
  • severe flail chest or pulmonary contusion
  • multiple trauma, head injury and abnormal mental status
  • inhalation injury with erythema/edema of the vocal cords
  • protection from aspiration

Description

To begin the procedure, an anesthesiologist opens the patient's mouth by separating the lips and pulling on the upper jaw with the index finger. Holding a laryngoscope in the left hand, he or she inserts it into the mouth of the patient with the blade directed to the right tonsil. Once the right tonsil is reached, the laryngoscope is swept to the midline, keeping the tongue on the left to bring the epiglottis into view. The laryngoscope blade is then advanced until it reaches the angle between the base of the tongue and the epiglottis. Next, the laryngoscope is lifted upwards towards the chest and away from the nose to bring the vocal cords into view. Often an assistant has to press on the trachea to provide a direct view of the larynx. The anesthesiologist then takes the endotracheal tube, made of flexible plastic, in the right hand and starts inserting it through the mouth opening. The tube is inserted through the cords to the point that the cuff rests just below the cords. Finally, the cuff is inflated to provide a minimal leak when the bag is squeezed. Using a stethoscope , the anesthesiologist listens for breathing sounds to ensure correct placement of the tube.

Preparation

For endotracheal intubation, the patient is placed on the operating table lying on the back with a pillow under the head. The anesthesiologist wears gloves, a gown and goggles. General anesthesia is administered to the patient before starting intubation.


Risks

The anesthesiologist should evaluate and follow the patient for potential complications that may include edema; bleeding; tracheal and esophageal perforation; pneumothorax (collapsed lung); and aspiration. The patient should be advised of the potential signs and symptoms associated with life-threatening complications of airway problems. These signs and symptoms include but are not limited to sore throat, pain or swelling of the face and neck, chest pain, subcutaneous emphysema, and difficulty swallowing.


Normal results

The endotracheal tube inserted during the procedure maintains an open passage through the upper airway and allows air to pass freely to and from the lungs in order to ventilate them.


Alternatives

Alternatives to endotracheal intubation include:

  • Esophageal tracheal combitube (ETC). The ETC is a double-lumen tube, combining the function of an esophageal obturator airway and a conventional endotracheal airway. The esophageal lumen has an open upper end, perforations at the pharyngeal level, and a closed distal end. The tracheal lumen has open ends. The lumens are separated by a wall and each is linked via a short tube with a connector. An oropharyngeal balloon serves to seal the oral and nasal cavities after
    The doctor inserts the laryngoscope into the patient's mouth, advancing through the trachea to the vocal cords (A). An endotracheal tube is inserted into the airway (B). The balloon cuff is inflated, and the laryngoscope is removed (C). (Illustration by GGS Inc.)
    The doctor inserts the laryngoscope into the patient's mouth, advancing through the trachea to the vocal cords (A). An endotracheal tube is inserted into the airway (B). The balloon cuff is inflated, and the laryngoscope is removed (C). (
    Illustration by GGS Inc.
    )
    insertion. At the lower end, a second cuff serves to seal either the trachea or esophagus.
  • Laryngeal mask airway (LMA). The LMA consists of an inflatable silicone ring attached diagonally to a flexible tube. The ring forms an oval cushion that fills the space around and behind the larynx. It achieves a low-pressure seal between the tube and the trachea without insertion into the larynx.
  • Tracheostomy. A tracheostomy is a surgically created opening in the neck that allows direct access to the trachea. It is kept open with a tracheostomy tube. A tracheostomy is performed when it is not possible to intubate the patient.

See also Anesthesia evaluation .


Resources

BOOKS

Finucane, B. T., and A. H. Santora. Principles of Airway Management. New York: Springer Verlag, 2003.

Roberts, J. T. Fundamentals of Tracheal Intubation. New York: Grune & Stratton, 1983.

Stewart, C. E. Advanced Airway Management. St. Louis: Quality Medical Publishing, 2002.

PERIODICALS

Bochicchio, G. V., et al. "Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury." Journal of Trauma Injury, Infections and Critical Care 54 (February 2003): 307–311.

Erhan, E., et al. "Tracheal intubation without muscle relaxants: Remifentanil or alfentanil in combination with propofol." European Journal of Anaesthesiology 20 (January 2003): 37–43.

Udobi, K. F., E. Childs, and K. Touijer. "Acute respiratory distress syndrome." American Family Physician 67 (January 2003): 315–322.

Van de Leur, J. P., J. H. Zwaveling, B. G. Loef, and C. P. Van der Schans. "Endotracheal suctioning versus minimally invasive airway suctioning in intubated patients: A prospective randomized controlled trial." Intensive Care Medicine 186 (February 8, 2003).

ORGANIZATIONS

American Society of Anesthesiologists. 520 N. Northwest Highway, Park Ridge, IL 60068-2573. (847) 825-5586. http://www.asahq.org/ .

OTHER

"Endotracheal intubation." Health_encyclopedia. <http://www.austin360.com/search/healthfd/shared/health/adam/ency article/003449.html> .

"Endotracheal intubation." PennHealth. http://www.penn health.com/ency/article/003449.htm .

"Intubation." Discovery_Health. <http://health.discovery.com/diseasesandcond/encyclopedia/1219.ht lgt; .


Monique Laberge, Ph.D.

User Contributions:

mra
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Nov 30, 2008 @ 6:06 am
This is very good and effectiveness.please send me new information.I am a resident of emergency medicine.
devaraj
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Sep 8, 2009 @ 3:03 am
THIS IS THE NICE ARTICLE, I NEED MORE INFORMATION ABOUT THIS ARTICLE AND ALSO ABOUT DIFFERENT TYPES OF TUBINGS
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Feb 14, 2010 @ 11:11 am
sory for not posting any comments, instead i would like to know postoperation vocal problem after intubation, actualy i was operated for appendix one month before, after two days of intubation i was having cough, but due to fresh suture i tried to control my cough and immediately i got hoarse sound which is till now not cured, i therefore would like to know is there any hope for my normal voice. I will be thankful for your reply.
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Aug 28, 2010 @ 6:18 pm
I was intubated recently for surgery. It is now 3 days past the surgery and I am still having pain every time I swallow. Even when I am just drinking water, it is bazaar, every time I swallow I have a air bubble that causes great pain about mid-sternem. Will this resolve??
Galene Haygood
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Jan 10, 2011 @ 1:13 pm
My sister had to have her thyroid removed. They said that the nodules from the thyroid had to be scraped off of her vocal chords. This resulted in having to be intubated due to the swelling anad inflamation of the soft tissue around the vocal chords. She had the trach for 3 months then the Dr's told her that 1/2 of her vocal chords were paralyzed. She sounds horrible when she talks, it has been terrible.That was over a year ago. Scince then she has had to have 4 total knee replacements and they tried not to intubate her again, but she was fighting so hard to breath they had to intubate her again. Now the vocal chords are even worse 6 weeks post op. Her ENT is having her cat scanned tomorrow to see what has happed to her vocal chords. TALK ABOUT COMPLICATIONS WITH BEING INTUBATED!!
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Jan 23, 2011 @ 2:14 pm
report for endotracheal Intubation which presented in ward class continuing education
kskuntryk
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Feb 10, 2011 @ 1:13 pm
i was intubated 7 weeks ago but still hav a little bit of sore throat that has not gone away is this common just alittle sor on left side when i swallow just wanting some info
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Mar 6, 2011 @ 8:20 pm
I was intubated just over a week ago. My teeth hurt so bad after and I couldn't open my mouth very wide. The weirdest feeling is right behind my two front teeth my gums/top pallet is numb. I didn't know and wasn't told my mouth would hurt so much after being intubated. I had a deviated septum repaired and some scare tissue removed from a break. How long will this last?
Julia
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Sep 15, 2011 @ 11:23 pm
LMA question. I have been intubated many times with Endotracheal tube without problem. I had general anethesia yesterday and awoke with a fairly severe ST. When I looked upon return home, I noted raw red areas on both sides of my throat and cuts in the area of the uvula and on the right side of my throat. Any ideas what could have caused this? I was prepared for a sore throat but cuts and the kind of irritation I saw was most unexpected.
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Sep 25, 2011 @ 11:23 pm
I HAD A TEE AND WAS INTUBATED ON JUNE 15TH 2011 FOR CARDIAC ABLATION. AFTERWARDS I HAVE THIS WEIRD FEELING IN MY THROAT. WHEN I TAKE A DEEP BREATH I COUGH A DRY COUGH. THIS ODD FEELING IS ALWAYS IN MY THROAT. WONDERING IF THIS IS GOING TO GO AWAY OR IS THEIR SOMETHING THAT HAPPENED DURING THE TEE OR THE INTUBATION.
vibel
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Nov 30, 2011 @ 11:23 pm
I HAVE A QUESTION REGARDING OF MY FATHER'S situation.my father intubated by the doctor because of unconsciousness.then after 3 hours my father is awake,stable,able to sit,and with stable vital signs and having a hard cough and chest pain during his cough.is it right that the doctor takes 21 hours to extubate my patient?if not right,what is the possible will be happen to my father?then my father is having a cardiomegaly and pulmonary edema.
cherri hairston
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Dec 27, 2011 @ 8:08 am
hubby had heart bypass surgery a a little over a week ago.He was on the ventilator for 6 days due to lung problems...He now has dysphagia..and is being fed by a tube.will this resolve and why is this happening.
Angela
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May 16, 2012 @ 3:15 pm
I wish someone would answer these questions. I also want to know if what I am feeling post-op is normal.
Jones
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Jun 4, 2012 @ 1:13 pm
I was intubated on Sept. 25th, 2011. Told the registration nurse that I was having problems swallowing and a little trouble breathing. She asked what medication I was taking and I told her Lisinopril. She immediately took me to the back and explained that I was having an allergic reaction to my blood pressure medication. I was intubated for 4 days. After release from the hospital, I felt like a had a lump in my throat. Was tested for thyroid problem and came back negative. Weeks later started having problems breathing. Was told I had bronchitis. It got worse and was hospitalized cause the oxygen level was low and could not breath. Thought they fixed the problem, but it started again. Went to a lung specialist and found out that I had tracheol stenosis which is the scaring of the trachea. Had 5 Bronchoscopy done and none healed my trachea. Now I have a tracheostomy tube in my neck. Could something been done differently?
Victor Magilke
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Aug 5, 2012 @ 11:23 pm
I had Carotd Endarterectomy. They had a difficult time with the traditional intubation and had to switch during surgery to the fiberoptic glide scope. I couldn't talk for several days and had excruciating pain in my lower right jaw. It has been nearly a month and it is extremely painful to chew or use my jaw. Is this normal and when will this pain subside?
marcie
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Nov 2, 2012 @ 3:15 pm
What does it mean when blood starts to come through the tube during intubation?
;/
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Feb 18, 2013 @ 5:05 am
I just know with high technology ETC is old process and there is a new technology to reduce deaths and after complications
Irmgard Alderman
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Jan 22, 2014 @ 1:13 pm
I am 6 weeks post op for an anterior cervical C5-C7 discectomy and fusion during which I was intubated. Aside from normal post op soreness which I fully understand, I am experiencing fullness, like food accumulating in the area, in the upper right chest accompanied with frequent burping and as of last week I have what feels like some type of loose scar tissue or membrane flapping in my pharyngeal area. I went to the ER, but they attributed it to "sore throat, which it is not. This problem sometimes closes the airway and also causes a gag reflex as something caught in the throat.
Any info on this would be appreciated.
mrs hensley
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Feb 18, 2014 @ 10:22 pm
I had surgery and was intubated and the tube pushed my gums from my jawbone and now I have to have oral surgery to fix. Soooi painful. Throat was extremely sore too. Bad experience.

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