What is intubation?
The aim of intubation is to ensure the function of the lungs in patients who cannot breathe on their own. Intubation is also an important measure to ensure that stomach contents, saliva or foreign bodies do not enter the trachea. It also allows physicians to safely deliver anesthetic gases and medications to the lungs. Depending on the experience of the person performing the procedure and the medical circumstances, there are various procedures:
- Intubation with laryngeal mask
- Intubation with Laryngeal Tube
- Fiberoptic intubation
In the hospital setting, endotracheal intubation is most commonly used. In this procedure, a plastic tube, called a tube, is inserted into the patient’s trachea. This is done either through the mouth or the nose. Once the patient is able to breathe on their own again, the tube is removed in a procedure called extubation.
When is intubation performed?
- Operations under general anesthesia
- Respiratory failure (severe respiratory insufficiency)
- Coma
- Cardiovascular arrest with resuscitation (resuscitation)
- severe injuries or swelling of the face or throat with (threatened) obstruction of the airways
- the ventilation of patients who have recently eaten or drunk.
- interventions in the area of the abdomen, chest, face and neck
- intubation during pregnancy
- the resuscitation of a patient
What do you do during intubation?
At the same time, the anesthesiologist injects the patient with a painkiller, a sleeping pill and a drug to relax the muscles. Once this mixture takes effect, the actual intubation can begin.
Endotracheal intubation
Intubation via the mouth
For intubation via the oral cavity (orotracheal intubation), the tube is now inserted directly into the mouth. The tube is carefully pushed along the metal spatula between the vocal cords several centimeters deep into the trachea.
Intubation via the nose
Another option is to insert the breathing tube through the nose (nasotracheal intubation). After administering decongestant nasal drops, a tube coated with lubricant is carefully advanced through one nostril until it lies in the throat. If necessary, a special forceps can be used to guide the tube further into the trachea.
Correction of the correct position
If nothing can be heard and the patient can be ventilated with the bag without much pressure, the chest should now rise and fall synchronously. Even with the stethoscope, a steady breathing sound should be heard over both sides of the chest.
This is important to ensure that the tube has not been advanced beyond the bifurcation of the trachea into one of the main bronchi. This is because then only one side of the lung, usually the right, would be ventilated.
The metal spatula is removed and the outer end of the tube is secured to the cheek, mouth and nose with, for example, strips of plaster to prevent it from slipping. The intubated person is now connected to a ventilator via tubes.
Extubation
Intubation with laryngeal mask and laryngeal tube
Particularly in emergencies or in the case of certain injuries, the physician does not necessarily have the opportunity to hyperextend the cervical spine and work his way into the trachea with the intubation tube. The laryngeal mask was developed for such cases.
Intubation with a laryngeal tube works on a similar principle. Here, too, the esophagus is blocked, but with a blind, rounded tube end. Further up, an opening above the larynx provides gas exchange.
Fiberoptic intubation
- has only a small mouth opening
- has limited mobility of the cervical spine
- suffers from inflammation of the jaw or loose teeth
- has a large, immobile tongue
The difference between this and normal intubation is that here the attending physician first makes the right path through the nostril with a so-called bronchoscope. This thin and flexible instrument carries a movable optics and a light source.
What are the risks of intubation?
Various complications can occur during intubation, especially in emergency situations. For example:
- Damage to the teeth
- Mucosal injuries in the nose, mouth, throat and trachea, which can lead to bleeding
- Bruising or laceration of the throat or lips
- Injuries to the larynx, especially the vocal cords
- Overinflation of the lungs
- Inhalation of stomach contents
- Malposition of the tube in the esophagus
- Cough
- Vomiting
- Tension of the laryngeal muscles
- increase or decrease in blood pressure
- Cardiac arrhythmia
- Respiratory arrest
Particularly in the case of prolonged intubation, irritation and damage to the mucous membrane of the trachea, mouth or nose may occur.
