What is Intubation and why is it Performed?

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Intubation is the process of inserting a tube called endotracheal tube (ET), through the mouth and then into the airways. This is done so that the patient can be placed in an artificial apparatus ventilation lung to facilitate breathing during anesthesia sedation or serious illness. The tube is then connected to a ventilator that pumps air into the lungs to provide breathing for the patient.

Intubation is done because the patient cannot maintain his or her airway, cannot breathe alone without help, or both. They may be under anesthesia and unable to breathe on their own during surgery, or they may be too sick or injured to provide enough oxygen to the body without help.

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Intubation purpose

When performing general anesthesia intubation is required. Numbing medications paralyze the muscles of the body, including diaphragm that makes it impossible to breathe without a respirator.

Most patients are extubated, which means the breathing tube is removed immediately after surgery. If the patient is very ill or has difficulty breathing on his or her own, he or she may stay in the mechanical ventilation machine for a longer period of time.

After most procedures, a drug is prescribed to reverse the action of anesthesia, allowing the patient to wake up quickly and start breathing on his own.

For some procedures, such as open-heart procedures, the patient does not receive medication to stop anesthesia and will slowly wake up on their own. These patients should remain in a machine for mechanical ventilation until they recover enough to protect their airways and breathe on their own.

Intubation is also performed in case of respiratory failure. There are many reasons why a patient may be too sick to breathe well enough on their own. They may have lung damage, they may have severe pneumonia, or breathing problems such as COPD.

If the patient cannot breathe in enough oxygen on his or her own, a ventilator may be needed until he or she becomes strong enough to breathe unaided.

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Intubation risks

While most surgeries carry a very low risk and intubation also carries a low risk, there are some potential problems that can arise, especially when the patient must remain in a mechanical ventilation machine for an extended period of time. Common risks include:

  • Injury to the teeth, mouth, tongue and / or larynx.
  • Accidental intubation into the esophagus (food tube) instead of the trachea (air tube)
  • Tracheal injury
  • Bleeding
  • Impossibility of weaning from mechanical ventilation apparatus requiring tracheostomy.
  • Inhalation (inhalation) of vomiting, saliva, or other fluids during intubation
  • Pneumonia if aspiration occurs
  • Sore throat
  • Hoarse
  • Soft tissue erosion (with prolonged intubation)

The medical team will assess and understand these potential risks and make every effort to address them.

Intubation Procedure

Before intubation, the patient is usually sedated or unconscious due to illness or injury, allowing the mouth and airways to relax. The patient usually lies on his or her back and the person inserting the tube stands at the head of the bed and looks at the patient’s feet.

The patient’s mouth opens gently and, with the help of an illuminated instrument, to prevent the tongue from interfering and illuminating the throat, the tube is gently inserted into the throat and advances into the airways.

There is a small balloon around the tube that inflates to keep the tube in place and prevent air from escaping. Once this balloon is inflated, the tube is securely placed in the respiratory tract and TIED or taped into the mouth.

Successful placement is first checked by listening to the lungs with a stethoscope and often checked with a chest X-ray. In the field or operating room, a device that measures carbon dioxide is used to confirm the correct placement of the tube, which would only be present if the tube was in the lungs and not the esophagus.

Nasal Intubation

In some cases, if the mouth or throat has surgery or has been injured, the breathing tube passes through the nose instead of the mouth, called a nasal intubation.

The nasotracheal (NT) tube passes through the nose, the back wall of the throat, and the upper airway. This is done so that the mouth remains empty and allows the surgery to be done.

This type of intubation is less common because it is usually easier to intubate using a larger mouth opening and because most simply do not need it.

Infant intubation

The intubation process is the same for adults and children, except for the Size of the equipment used during the process. A small child needs a much smaller tube than an adult, and tube installation may require a greater degree of precision because the airways are much smaller.

In some cases, a fiber-optic viewfinder is used to facilitate intubation, a tool that allows the person inserting the breathing tube to observe the process on a Monitor.

The actual tube installation process is essentially the same for adults as for older children, but nasal intubation is preferable for newborns and babies. Preparing a child for surgery is very different from preparing an adult.

While an adult may have questions about coverage, risks, benefits, and timing of recovery, the child will need a different explanation of the process that is happening. Trust is needed, and emotional preparation for surgery it will vary depending on the age of the patient.

Feeding During Intubation

A patient who will be on a mechanical ventilation machine during the procedure and then extubated after the procedure is completed will not need feeding, but may receive fluids through a drip. If the patient is expected to depend on the Ventilator for two or more days, feeding usually begins one or two days after intubation.

It is not possible to take food or liquids by mouth during intubation, at least not in the way that is normally done by biting, chewing, and then swallowing. 

To be able to safely take food, medicine, and fluids through the mouth, a tube is inserted into the throat and down into the stomach. This tube is called an orogastric (OG) when it is inserted into the mouth, or nasogastric (NG) when it is inserted into the nose and sinks into the throat. Medicines, fluids, and food through the tube are pushed through the tube into the stomach with a large syringe or pump.

For other patients, food, fluids, and medicines should be given intravenously. Intravenous nutrition, called TPA or complete parenteral nutrition, provides nutrition and calories directly into the bloodstream in liquid form. This type of feeding is usually avoided without extreme need, as food is better absorbed through the intestine.

Breathing tube removal

The tube is much easier to remove than to install. When it’s time to remove the tube. you must first remove the ties or tape that holds it in place. The balloon that holds the tube in the respiratory tract is then deflated so that the tube can be gently removed. Once the tube is removed, the patient will have to do the breathing work on their own.

Do not Intubate / Resuscitate

Some patients report their wishes through an extended directive, a document that clearly states their wishes with regard to health care. Some patients choose the “do not intubate” option, which means they do not want to be connected to a mechanical ventilation machine to prolong their lives. “Do not resuscitate” means that the patient prefers not to do artificial respiration.

The patient controls this option, so they can temporarily change this option to perform surgery that requires mechanical ventilation. But it is a mandatory legal document that cannot be modified by other people under normal circumstances.

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The need for intubation and placement in mechanical ventilation is common with general anesthesia, which means that most surgeries will require this type of care. Although it’s scary to think about being in a mechanical ventilation machine, most patients who have surgery breathe on their own within minutes of finishing surgery.

If you are concerned that you are in a mechanical ventilation machine during surgery, be sure to discuss your concerns with your surgeon or the person giving your anesthesia.

Frequently asked questions

  • “Do not intubate” (DNI) is a decision made before surgery by a person who does not want to be connected to a mechanical ventilation machine. This means that the intubation process, in which a tube is inserted through the mouth into the respiratory tract to make breathing easier, is not used.

  • Staying awake in a mechanical ventilation machine is possible, but people usually receive a sedative to prevent this. When a person is placed on a mechanical ventilation machine, he or she is given medicine to make him or her feel comfortable and want to sleep. This medicine can make wakefulness difficult for a long time.

  • Most people who are intubated stay in the machine for several hours, days, or weeks. However, in some cases, when people still require artificial respiration, they may remain intubated for months or years.

  • Extubation is the removal of the breathing tube. If a person no longer needs assisted breathing, he or she disconnects from the mechanical ventilation machine as soon as possible.

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