What is intubation ?
The insertion of a long breathing tube or artificial airway (endotracheal tube - ETT) into the trachea (wind pipe) via the mouth is called intubation. On occasion the tube may be inserted through the nose down into the trachea.
A patient will require intubation when they are unable to breath for themselves. This may be as a result of a disease process or certain drugs e.g. anaesthetic drugs drugs. Once intubated a patient will usually be attached to a breathing machine (ventilator). Together this equipment will take over some or all of the work of breathing until the patient is able to do this for themselves. A team of trained clinicians, normally headed by a doctor, completes the intubation procedure. This team works in a coordinated way to ensure that the procedure is completed in a safe and timely manner.
What is done?
The patient is laid down with a bedside monitor attached to continually assess vital functions. Intravenous cannulae are required for the administration of the drugs and fluids. The patient is given an anaesthetic to put them to sleep. The doctor uses a laryngoscope to open the mouth up and see down the throat and passes the ETT through the mouth and into the trachea (wind pipe). The cuff of the ETT is blown up using the pilot tube. This creates a seal around the tube within the trachea. The correct position is checked in several different ways and then the tube is anchored to the patient using white tape, adhesive tape or a plastic device. The patient will then be attached to a ventilator (breathing machine) to assist with breathing. A chest X-ray is done as the final check.
In intensive care once a patient is intubated they may be given a continuous infusion of a sedative drug so that they can tolerate the ‘tube’. This will be individualised for each patient. The patient will be unable to talk because the ETT prevents the passage of air through the voice box. However most will be able to respond in some way so talking to them in a quiet way is a good idea. If the patient is awake the nurse will explain to him why he has the breathing tube in position and reassure him that he should continue to breath in a relaxed fashion. Under rare circumstances a patient will be intubated because they have an obstruction in their airways such as swelling or infection. It may not be necessary for these patients’ to have a breathing machine (ventilator).
Once the patient’s condition allows the tube will be removed, this is called extubation.
The original illustration was taken from http://www.aic.cuhk.edu.hk/web8/Intubation.htm and labels applied only.
What are the risks?
The most common complication occurs when the breathing tube is placed incorrectly. This will be evident through the assessment of several vital signs. However these problems are evident very quickly and there are a number of checks, which are undertaken by the clinician after intubation to ensure correct placement. The patient will have a CXR as soon as possible following intubation to verify the position of the tube.
There can be complications with any procedure even when carried out by skilled clinicians. The treating doctor will explain the complications that may occur.
All Intensive Care procedures carry a degree of risk even when performed by skilled and experienced staff. Please discuss these issues with the medical and nursing staff who are caring for the patient and o f course, if you have any questions or concerns, please ask the ICU nurses and doctors.
Intubation Version 1 June 2006 (K Rolls CNC ICCMU) First posted July 2006
The information contained on this page is general in nature and therefore cannot reflect individual patient variation. In addition it reflects Australian intensive care practice which may differ from other countries. It is meant as a back up to specific information which will be discussed with you by the Doctors and Nurses caring for your loved one. ICCMU attests to the accuracy of the information contained here BUT takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.