Intubation is the process of inserting a tube called an endotracheal tube (ET) into the mouth or nose and then into the airway (trachea) to hold it open. Once in place, the tube is connected to a machine called a ventilator (or a bag that gets squeezed, if not accessible) to push air in and out of the lungs.
There are several reasons why intubation is needed, but it is mainly used to support breathing during surgery or in an emergency. Et Tube Holder
This article goes over the different types of intubation, how intubation is done, and the risks of being intubated.
The reason someone is being intubated dictates which of the two types of intubation will be used.
Endotracheal intubation is when the tube is inserted through the mouth. It used in most emergency situations because the tube that gets placed through the mouth is larger and easier to insert than the one inserted through the nose.
Endotracheal intubation is used to:
Nasotracheal intubation is when the tube is put in through the nose. It is used to:
Intubation is a common procedure. In the United States alone, at least 15 million intubations are performed in an operating room and another 650,000 are performed outside of an operating room each year.
Here's what to expect if you need to be intubated:
Before endotracheal intubation, a person needs to be sedated if they are not already unconscious. From there, the steps of endotracheal intubation are as follows:
The process of nasotracheal intubation is similar to endotracheal intubation, but the person may either be fully or partially sedated.
Since nasal intubation is more often performed in a controlled environment, there can be other tools involved in the process.
For example, a provider can use a decongestant spray to prevent nosebleeds, a topical anesthetic to reduce pain, and a muscle relaxant to prevent gagging. Some providers will also widen the passage with a device called a nasal trumpet.
Once the tube is fed into the nostril and enters the middle part of the throat, a fiberoptic scope called a laryngoscope helps guide the tube between the vocal cords and into the windpipe.
The tube is then inflated to secure it in the trachea and taped on the outside to keep it from moving.
Most people are not awake and conscious while they are being intubated. If they are, providers can help ease the pain of intubation with treatments like throat-numbing sprays and sedation.
It is not possible to eat or take fluids by mouth while intubated. If an intubated person needs to be on a ventilator for two or more days, tube feeding will typically start a day or two after the tube is put in. This is referred to as enteral nutrition.
Nutrition, fluids, and medication can be delivered through the feeding tube, which is either passed through the mouth or nose and then into the stomach.
Total parenteral nutrition (TPA), when nutrition is given through a needle in their arm, is an option for people with severe malnutrition and weight loss; people with a blockage in their intestines, and people with diseases that make tube feeding impossible.
Intubation and ventilation go hand-in-hand, but they are distinct elements of the steps taken to help someone breathe.
Intubation is simply the process of placing the tube that protects the airway, keeping an open passageway to the lungs.
Ventilation is the process by which air is mechanically moved in and out of the lungs when someone is unable to do that—either well or at all—themselves. The machine (or bag) does the breathing for them until they can breathe on their own.
While being awake on a ventilator is possible, people are usually sedated to help prevent anxiety or discomfort. When a person is placed on a ventilator, they can be given monitored anesthesia to induce "twilight sleep" or general anesthesia to put them fully asleep.
This video has been medically reviewed by Rochelle Collins, DO.
Most people experience only mild side effects like sore throat and hoarseness as a result of intubation. Some people have no symptoms and never even realize they were intubated.
However, there are some risks of intubation that can be serious, especially in people who need to be on a ventilator for a long period of time.
Common risks of intubation include:
Tracheal stenosis, or a narrowing of the trachea, is also possible.
Sometimes, a person cannot be intubated safely. In these situations, intubation is not advised.
A person might not be able to be intubated if they:
In a life-or-death situation, providers might decide that the benefits of intubating a patient outweigh the risks.
The process of intubation is more or less the same for adults and children, aside from the size of the tube and some of the equipment that can be used.
Newborns are hard to intubate because of their small size. The procedure is also more difficult in little ones because a baby's tongue is proportionately larger and the passage into their windpipe is proportionately longer and less flexible.
Nasal intubation is the preferred method for newborns and infants, though it can take several attempts to properly place the tube.
Extubation is the process of removing a tracheal tube. It is usually easier and faster to take the tube out than it is to put it in.
Extubation involves the following steps:
Most people who are intubated stay on a ventilator for a matter of hours, days, or weeks. However, people on life support or those with chronic hypoventilation caused by severe neuromuscular disorders and other conditions might stay on a ventilator for months or years.
Coughing, hoarseness, and discomfort are common symptoms after extubation, but they tend to improve within a few days. Some people may also experience difficulty swallowing or talking while the throat and voice box recover from inflammation and irritation.
If you continue to experience difficulty talking or swallowing within a few weeks of being intubated, contact your healthcare provider. Your provider may refer you to an otolaryngologist (ear, nose, and throat specialist) to help you recover fully.
Intubation is the insertion of a tube either through the mouth or nose and into the airway to aid with breathing, deliver anesthesia or medications, and bypass a blockage.
It is called endotracheal intubation when the tube is inserted into the mouth and a nasogastric tube when the tube is fed through a nostril. The procedure for both is largely the same.
There are risks associated with intubation, but the benefits of intubation generally outweigh the risks.
Folino TB, McKean G, Parks LJ.Nasotracheal intubation.In: StatPearls [Internet].
Turner J, Bucca A, Propst S, et al. Association of checklist use in endotracheal intubation with clinically important outcomes: A systematic review and meta analysis. JAMA Netw Open. 2020;3(7):1-12. doi:10.1001/jamanetworkopen.2020.9278
Artune CA, Hagberg CA.Tracheal extubation.I breathe Which.2014 Jun;59(6):991-10025.doi:10.4187/respcare.02926
Fremont RD, Rice TW. How soon should we start interventional feeding in the ICU?. Curr Opin Gastroenterol. 2014 Mar; 30(2): 178–181. doi:10.1097/MOG.0000000000000047
American College of Gastroenterology. Enteral and parenteral nutrition.
Ball L, Pelosi P. Intraoperative ventilation and postoperative respiratory assistance. BJA Education. 2017;17(11):357–362. doi:10.1093/bjaed/mkx025
Tikka T, Hilmi OJ. Upper airway tract complications of endotracheal intubation. Br J Hosp Med (Lond). 2019 Aug;80(8):441-7. doi:10.12968/hmed.2019.80.8.441
Chapter 22. Nasotracheal Intubation. In: Reichman EF. eds. Emergency Medicine Procedures, 2e. McGraw Hill; 2013.
Greene NH, Jooste EH, Thibault DP, et al. A study of practice behavior for endotracheal intubation site for children with congenital heart disease undergoing surgery: Impact of endotracheal intubation site on perioperative outcomes-an analysis of the Society of Thoracic Surgeons Congenital Cardiac Anesthesia Society database. Anesth Analg. 2018. doi:10.1213/ANE.0000000000003594
Ibarra-Sarlat M, Terrones-Vargas E, Rosemary- Spinoza L, Chestnut-Muccino G, Blacksmith-Landero A, Nunez-Enriquez JC.Endotracheal intubation in children: practice recommendations, insights, and future directions.In: IntechOpen [Internet].
By Jennifer Whitlock, RN, MSN, FN Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.
Thank you, {{form.email}}, for signing up.
There was an error. Please try again.
Ett Airway By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.