What is intubation?
Intubation is a medical procedure. It involves inserting a hollow intubation tube into the trachea—or windpipe. The tube provides a way to keep the airway open and to view the upper airway. The upper airway is the mouth and throat, which includes the voice box and vocal cords. Other names for the procedure include artificial airway, airway management, and endotracheal intubation.
There are two main types of intubation procedures:
- Nasotracheal intubation, which inserts the intubation tube through the nose and down in the trachea. Doctors typically use this approach in people who are awake and there is a need to avoid using the mouth.
- Orotracheal (endotracheal) intubation, which inserts the tub through the mouth. This is the most common type of intubation. It is the preferred method, especially in emergency situations, because it is usually faster.
After insertion, doctors can connect the intubation tube to a mechanical ventilator to do the work of breathing.
Why is intubation performed?
Doctors use intubation as part of critical care and in anesthesiology. In anesthesiology, intubation provides a way to keep a person breathing general anesthesia. This is necessary because general anesthesia suppresses breathing and other automatic body functions.
In critical care, uses of intubation include:
- Preventing aspiration—breathing fluid into the lungs—in conditions such as stroke, overdose, and severe bleeding in the esophagus or stomach
- Protecting the airway when there is a blockage, trauma or unconsciousness
- Suctioning and removal of fluids from the trachea
- Treating respiratory failure due to conditions such as pneumonia, collapsed lung, or shock
- Viewing the status of the upper airway
Who performs intubation?
Doctors who perform intubation include anesthesiologists, critical care doctors, and emergency medicine doctors. An anesthesiologist specializes in relieving pain and providing total medical care for patients before, during and after surgery. A critical care medicine doctor cares for patients who are hospitalized with acute, life-threatening illnesses or injuries. An emergency medicine doctor specializes in emergency care of people with serious and life-threatening illnesses and injuries.
In emergency situations outside the hospital, an EMT (emergency medical technician) can perform intubation.
How is intubation performed?
In most cases, intubation takes place in a hospital while you are unconscious. Doctors give sedatives and muscle relaxants before starting the process in conscious or semi-conscious people. For example, if you will need intubation with anesthesia, you will have these medicines as IVs or gases before the intubation process.
Once you are unconscious, the doctor will insert a laryngoscope—a tool that allows the doctor to see the vocal cords and upper windpipe. Then, the doctor will insert the intubation tube, using the laryngoscope to verify placement. It’s important to make sure the tube passes through the vocal cords correctly. After the tube is in the proper place, doctors can connect it to a mechanical ventilator to support breathing.
What are the risks and potential complications of intubation?
Since intubation is a critical or emergency procedure, the benefits generally outweigh the risks.
Potential complications of intubation
Most intubations are successful, but potential complications include:
- Abnormal heart rhythms
- Accidental placement into the esophagus
- Bleeding
- Damage to the lips, tongue, teeth, windpipe, voice box, vocal cords, thyroid gland, or esophagus
- Infection
- Trauma to tissues in the chest cavity, leading to a collapsed lung
Reducing your risk of complications
In critical and emergency situations, there are no steps you can take to reduce the risk of complications.
What can I expect after intubation?
After the intubation procedure, you may or may not be conscious. Your healthcare team will give you medicines to relax you and keep you comfortable while the tube remains in place.
Will I feel pain?
You should not feel pain during the intubation procedure. You will either be unconscious or the doctor will numb your throat before performing the intubation.
How might intubation affect my everyday life?
Intubation can be a life-saving procedure. However, you have the right to plan your care, including whether or not you want to be intubated. If this is not something you want, talk with your doctor before the need arises, if possible. Ask your doctor to include a DNI (do not intubate) order in your medical record. Choosing not to have intubation as part of your care can result in decreased oxygen levels, respiratory failure, and death.
