Endotracheal Intubation: Tube Types, Purpose, Complications and Extraction

It is a procedure by which a tube is inserted through the mouth down into the trachea (the large airway from the mouth to the lungs).

Before surgery, this is often done under deep sedation. In emergencies, the patient is usually unconscious during this procedure.

Intubation is inserting a tube, called an endotracheal line (ET), through the mouth and then into the airway. This is done so that a patient can be placed on a ventilator to help with breathing during anesthesia, sedation, or severe illness.

The tube is then connected to a ventilator, which pushes the air into the lungs to support the patient’s breathing.

This process is done because the patient can not maintain their airways, can not breathe independently without help, or both.

This can happen because you are receiving anesthesia and will not be able to breathe on your own during surgery, or you may be too sick or injured to provide enough oxygen to the body without help.

What type of tube is used?

The tube used today is usually a flexible plastic tube. It is called an endotracheal tube because it slides inside the trachea.


How intubation is done

Before intubation, the patient is usually sedated or not conscious due to illness or injury, which allows the mouth and airway to relax. The patient is generally flat on the back, and the person inserting the tube is standing at the head of the bed, looking at the patient’s feet.

The patient’s mouth opens smoothly, and with an illuminated instrument to keep the tongue out of the way and inspire the throat, the tube is gently guided into the throat and advanced towards the airway.

A small balloon around the tube is inflated to hold the line in place and prevent air from escaping. Once this balloon is raised, the box is well placed in the airway and tied or glued in the mouth.

The doctor often inserts the tube with the help of a laryngoscope, an instrument that allows the doctor to see the upper portion of the trachea, just below the vocal cords. The laryngoscope is used to keep the tongue to one side while inserting the tube into the trachea during the procedure.

The head must be positioned appropriately to allow adequate visualization. The pressure is often applied to the cartilage of the thyroid (Adam’s apple) to help with visualization and prevent possible aspiration of stomach contents.

What is the purpose of endotracheal intubation?

The endotracheal tube serves as an open passage through the upper airway. Endotracheal intubation aims to allow air to pass freely to and from the lungs to ventilate the lungs.

Endotracheal tubes can be connected to ventilation machines to provide artificial respiration. This can help when a patient is unconscious and maintaining a patent airway, especially during surgery.

It is often used when patients are seriously ill and can not maintain adequate respiratory function to meet their needs. The endotracheal tube facilitates the use of a mechanical ventilator in these critical situations.

Intubation is required when general anesthesia is administered. Anesthetic drugs paralyze the body’s muscles, including the diaphragm, making it impossible to breathe without a ventilator.

Most patients are extubated, meaning the breathing tube is removed immediately after surgery.

If the patient is very ill or has difficulty breathing independently, they can remain on the ventilator for a more extended period.

After most procedures, a medication is given to reverse the effects of anesthesia, allowing the patient to wake up quickly and start breathing independently.

For some procedures, such as open-heart procedures, the patient does not receive the medication to reverse the anesthesia and wakes up slowly on his own.

These patients will need to stay on the ventilator until they are awake enough to protect their airways and take breaths independently.

Intubation is also performed due to respiratory failure. There are many reasons why a patient may be too sick to breathe enough independently.

They may have a lung injury, severe pneumonia, or a respiratory problem such as COPD.

If a patient can not take enough oxygen by himself, a ventilator may be necessary until it is once again strong enough to breathe without help.

What are the possible complications?

There will be no adequate respirations if the tube is inadvertently placed in the esophagus (just behind the windpipe). Brain damage, cardiac arrest, and death can occur. Aspiration of stomach contents can result in pneumonia.

Placing the tube too deep may result in only one lung being ventilated, pneumothorax, and inadequate ventilation.

During placement of the endotracheal tube, damage can also occur to the teeth, soft tissues in the back of the throat, and the vocal cords.

A doctor with experience in intubation should perform this procedure. In the vast majority of cases of intubation, no significant complications occur.

Extraction of the respiratory tube

The tube is much easier to remove than to place. When it is time to draw the line, the loops or tape that hold it should be removed first.

Then, the balloon that holds the tube in the airway is deflated so that the line can be pulled out smoothly.

Once the tube is out, the patient will have to do the breathing work independently.