Intubation

What is intubation?

Intubation (in-too-BEY-shuhn) is a process in which a healthcare provider inserts a breathing tube through your mouth or nose, then down into your windpipe (trachea). The tube keeps your trachea open so air can get through. The tube can connect to a machine that delivers air or oxygen with pressure (mechanical ventilation).

Other names for intubation include:

• Airway intubation
• Endotracheal intubation (ETT)
• Tracheal intubation

Why would you intubate a patient?

A healthcare provider may need to intubate you when a blockage or damage to your airways keeps you from breathing. Some conditions that can lead to intubation include:

• Injury or trauma to your abdomen, chest or neck that affects your airways
• Loss of consciousness (fainting) or a low level of consciousness, which can make you lose control of your airway
• Need for surgery that will make you unable to breathe on your own
• Respiratory failure
• Risk for breathing in an object or substances, like food, vomit or blood (aspiration)
• Something is caught in your airway and blocking the flow of air (airway obstruction)
• Sudden loss of heart function (cardiac arrest)
• A temporary stop in breathing (apnea)

How common is it?

Intubation is a very common lifesaving procedure. Each year in the U.S., healthcare providers perform intubation approximately:

• 15 million times in operating room (OR) situations
• 650,000 times outside of the OR, including 346,000 times in the emergency department

What happens during endotracheal intubation?

Most intubation procedures happen in the hospital. Sometimes, emergency medical services (EMS) personnel intubate people outside of a hospital setting.

During endotracheal intubation, healthcare providers will:

1. Insert an intravenous (IV) needle into your arm
2. Deliver medications through the IV so you fall asleep and don’t feel pain during the procedure (anesthesia)
3. Place an oxygen mask over your nose and mouth to give your body extra oxygen
4. Tilt your head back and insert a laryngoscope in your mouth (or your nose when necessary); a laryngoscope has a handle, lights and a dull blade, which help providers guide the tracheal tube
5. Move the laryngoscope toward the back of your mouth, avoiding your teeth
6. Raise the flap of tissue that hangs in the back of your mouth (epiglottis) to protect your voice box (larynx)
7. Advance the tip of the laryngoscope into your larynx and then into your trachea
8. Inflate a small balloon around the endotracheal tube to make sure it stays in place in your trachea and that all air from the tube reaches your lungs
9. Remove the laryngoscope
10. Place tape on the sides of your mouth or a strap around your head to keep the tracheal tube in place
11. Ensure that the tube is in the right place by taking an X-ray or squeezing air through a bag into the tube and listening for breath sounds

How long does intubation take?

In an emergency, a healthcare provider can complete intubation in less than a minute.

Can a person talk or eat while intubated?

No. The endotracheal tube passes through your vocal cords, so you won’t be able to speak.

You also can’t swallow while intubated, so you can’t eat or drink. Depending on how long you’ll need intubation, healthcare providers may give you a peripheral IV to provide liquid nutrition (enteral nutrition) or IV fluids. They may also deliver them through a separate slim tube that they insert in your mouth or nose, which ends in your stomach or small intestine (small bowel).

How is the tracheal tube removed during extubation?

When healthcare providers decide it’s safe, they’ll remove the tube (extubation). They’ll:

1. Remove the tape or strap holding the tube in place
2. Use a suction device to remove any debris from your airway
3. Deflate the balloon inside your trachea
4. Tell you to take a deep breath and then cough or exhale while they pull out the tube

Your throat (pharynx) may be sore for a few days after extubation. You also may have trouble speaking.

What are the benefits of intubation?

Intubation is a common and generally safe procedure that can help save your life. The benefits of intubation far outweigh any possible risks.

What is the survival rate of being intubated?

The intubation survival rate varies according to many factors, including the reason for intubation, your age and your overall health. But according to one study, a little less than 7 out of every 10 people survive intubation in an emergency department setting.

What are the risks of intubation?

Though intubation is generally safe, risks may include:

• Aspiration: During intubation, you may inhale vomit, blood or other fluids into your lungs.
• Endobronchial intubation: The tracheal tube may go down one of the two tubes that connect your trachea to your lungs (bronchi). Another name for endobronchial intubation is mainstem intubation.
• Esophageal intubation: If the tracheal tube enters your food tube (esophagus) instead of your trachea, it can cause brain damage or death if a provider doesn’t recognize it quickly.
• Failure to secure the airway: When intubation doesn’t work, providers may not be able to treat you.
• Infections: You may develop a bacterial infection after intubation, like a sinus infection.
• Injury: Intubation can potentially injure your mouth, teeth, tongue, vocal cords or airway. An injury may lead to bleeding or swelling.
• Problems coming out of anesthesia: Most people recover from anesthesia well. But some have trouble waking up or other problems, like fever and muscle cramps (malignant hyperthermia) or temporary or permanent nerve damage.
• Tension pneumothorax (collapsed lung): Trapped air in your chest cavity can cause your lungs to collapse.

Who should not be intubated?

In some cases, healthcare providers may decide that it’s not safe to intubate. This may happen if there’s severe trauma to the airway or an obstruction prevents providers from safely placing the tube.

In these cases, providers may decide to surgically open your airway through your throat at the bottom of your neck (tracheostomy). A tracheostomy is often necessary when you have an endotracheal tube in place for more than a few days or when you’re expected to have it for weeks.

How long does it take to recover?

Most people recover from intubation in a few hours or days. Reach out to a healthcare provider if you still have problems with coughing, swallowing or talking a few weeks after intubation. They may refer you to a head and neck specialist (otolaryngologist).

When should I call my healthcare provider?

Immediately contact a healthcare provider if you experience any of the following symptoms after intubation:

• Chest pain
• Difficulty breathing, including shortness of breath
• Difficulty or inability to speak or swallow
• Severe sore throat
• Swelling in your face

How serious is it to be intubated?

It depends on why you need intubation. Healthcare providers sometimes use intubation during scheduled surgeries. But in emergency situations, intubation acts as a form of life support when you can’t breathe on your own.

What is the difference between being intubated and being on a ventilator?

Intubation and mechanical ventilation relate to each other. But they’re not exactly the same.

Intubation is the process of inserting an endotracheal tube into the airway. A healthcare provider then hooks the tube up to a device that delivers air. The device can be a bag that the provider squeezes to push air into your body, or it can be a ventilator. A ventilator is a machine that blows oxygen into your airway and lungs. Sometimes, a ventilator delivers air through a mask, not a tube.

What is nasotracheal intubation?

Nasotracheal intubation is when healthcare providers insert a tube through your nose. Providers commonly use it if you need surgery in your head, mouth or neck. You may also need nasotracheal intubation to help prevent additional trauma to your neck or windpipe.