Intubation is a medical procedure commonly used in emergency settings, surgeries, and intensive care units to secure a patient’s airway.
It involves the insertion of a tube into the trachea, allowing healthcare professionals to ensure that the patient can breathe effectively or that a ventilator can assist with breathing. This technique is essential for maintaining gas exchange in critical situations, such as during respiratory failure or surgery.
In this article, we will explore the different types of intubation, the step-by-step process, and the risks and benefits associated with this life-saving procedure.
What is Intubation?
Intubation is a medical procedure in which a flexible tube, known as an endotracheal tube, is inserted through the mouth or nose into the trachea to maintain an open airway. This is typically done in situations where a patient is unable to breathe on their own or requires assistance with breathing, such as during surgery, severe illness, or trauma.
The tube ensures that air can pass into the lungs or that a ventilator can deliver oxygen and remove carbon dioxide. Intubation is commonly performed in emergency settings, intensive care units, and operating rooms.
Indications
Intubation is often necessary in situations where a patient’s ability to breathe or maintain an open airway is compromised.
Some of the most common indications include:
- Apnea: When a patient stops breathing.
- Respiratory failure: Inability to maintain adequate gas exchange, resulting in dangerously low oxygen or high carbon dioxide levels.
- Severe hypoxemia: Critically low blood oxygen levels despite supplemental oxygen.
- Decreased consciousness: When a patient’s level of consciousness is impaired, posing a risk to their airway.
- Altered mental status: Cognitive changes that may hinder the patient’s ability to protect their airway.
- Airway trauma or injury: Damage to the airway that obstructs normal breathing.
- Airway obstruction: Blockages due to foreign bodies, swelling, or other causes that hinder airflow.
- Risk of aspiration: When there’s a danger of stomach contents entering the lungs.
- Cardiac arrest: When the heart stops, and immediate intervention is required to maintain oxygenation.
- Hemodynamic instability: When the patient’s blood pressure or circulation is compromised, requiring airway management.
- Cardiopulmonary resuscitation (CPR): During resuscitation efforts to maintain ventilation.
Note: Since a patient cannot survive without proper oxygenation and ventilation, intubation and mechanical ventilation are typically considered essential interventions.
Contraindications
There are no absolute contraindications to intubation except in cases where a patient has explicitly and legally refused life support.
This is known as an advance directive, where the patient has made a legal decision to forego life-sustaining treatment, even in life-threatening situations.
Types of Intubation
There are two main types of intubation procedures, each used depending on the clinical situation:
- Oral intubation
- Nasal intubation
Note: The choice between these two methods depends on various factors, including patient condition and the specific needs of the procedure.
Oral Intubation
Oral intubation is a procedure where the endotracheal tube is inserted through the mouth and into the trachea.
This method is generally preferred for its several advantages:
- Easier and quicker to perform.
- Less traumatic during insertion.
- Allows for the use of a larger tube, which reduces airway resistance and the work of breathing.
- Easier to suction the airway.
- Less risk of tube kinking or occlusion.
- Facilitates bronchoscopy procedures.
- Reduces the risk of nasal trauma and complications.
However, oral intubation has its limitations and risks, such as:
- Higher risk of mainstem intubation, where the tube enters the right main bronchus, resulting in only the right lung being ventilated.
- Greater chance of self-extubation, where patients may accidentally remove the tube.
- Increased risk of vomiting and aspiration of stomach contents.
- Potential for oral trauma and tube occlusion (e.g., due to biting the tube).
Nasal Intubation
Nasal intubation involves inserting the endotracheal tube through the nose and into the trachea. This approach is typically used when oral intubation is not feasible, such as when there are obstructions, difficult airways, or conditions affecting the mouth.
Some of the advantages of nasal intubation include:
- More comfortable for long-term intubation.
- Less gagging, making it more tolerable for patients.
- Allows for better communication and oral hygiene.
- Less risk of biting the tube or developing oral complications.
- Reduced chance of self-extubation.
- Lower risk of mainstem intubation.
- Can improve nutritional support for patients.
- Often does not require the use of sedatives or muscle relaxants.
Despite these benefits, nasal intubation has notable drawbacks:
- It is generally more difficult to perform.
- A smaller tube must be used, leading to increased airway resistance and work of breathing.
- There is a higher risk of nasal complications, such as sinusitis, epistaxis (nosebleeds), and otitis (ear infections).
- Suctioning is more challenging compared to oral intubation.
Note: Each type of intubation has specific indications, and the choice depends on the patient’s condition and the goals of treatment.
Intubation Equipment
To successfully perform endotracheal intubation, having the correct equipment on hand is essential for ensuring patient safety and the procedure’s effectiveness.
The necessary tools include:
- Personal protective equipment (PPE): Gloves, gowns, masks, and face shields to protect healthcare providers from potential exposure to bodily fluids.
- Oxygen flowmeter and delivery source: To provide oxygen before, during, and after the procedure.
- Suction machine and vacuum source: Essential for clearing secretions or obstructions from the airway.
- Sterile suction catheters: Used to remove fluids or debris from the airway during intubation.
- Yankauer tip suction catheter: A rigid suction tool for clearing the mouth and throat of secretions.
- Bag-valve mask (BVM): For manual ventilation of the patient before or during intubation.
- Colorimetric CO2 detector: To confirm correct endotracheal tube placement by detecting exhaled CO2.
- Laryngoscope and blades: Used to visualize the airway and guide the endotracheal tube into place.
- Endotracheal tubes (various sizes): Multiple sizes should be available to accommodate different patients and ensure a proper fit.
- Stylet: A stiff wire used to guide and shape the endotracheal tube during insertion.
- Stethoscope: For auscultation to verify tube placement and assess lung sounds.
- Tape or tube holder: To secure the endotracheal tube and prevent displacement.
- 10 mL syringe: To inflate the cuff on the endotracheal tube, creating a seal in the trachea.
- Magill forceps: Used during nasal intubation to guide the tube into the trachea.
- Water-soluble lubricating gel: To reduce friction and ease the insertion of the endotracheal tube.
Note: Each piece of equipment serves a crucial role, from visualizing the airway and inserting the tube to securing it and confirming proper placement. Having all the necessary tools readily available helps ensure a smooth and successful intubation.
What is an Endotracheal Tube?
An endotracheal tube (ET tube) is a flexible plastic tube that is inserted into a patient’s trachea (windpipe) through the mouth or nose to secure an open airway and ensure proper ventilation.
This tube is typically used during procedures such as surgery, in critical care situations, or when a patient cannot breathe effectively on their own. The ET tube allows healthcare providers to deliver oxygen, remove carbon dioxide, and maintain lung function.
It also protects the airway from aspiration, which is when foreign materials, such as stomach contents, enter the lungs.
The tube is equipped with an inflatable cuff at the lower end that forms a seal inside the trachea, ensuring that air flows into the lungs rather than escaping around the tube. Endotracheal tubes come in various sizes to accommodate different patients, from infants to adults.
Intubation Procedure
The endotracheal intubation procedure follows a series of critical steps to ensure the airway is secured effectively:
- Verify the order: Confirm the doctor’s order. In emergency situations, the physician is typically present to oversee the procedure.
- Prepare equipment: Assemble all necessary equipment, testing each piece to ensure it is functioning correctly before beginning.
- Administer medications: Administer sedatives or paralytics as needed (PRN) to ensure the patient is comfortable and immobile.
- Pre-oxygenate the patient: Hyperoxygenate the patient with 100% oxygen for 2–3 minutes using a manual resuscitator (bag valve mask) to increase oxygen reserves before attempting intubation.
- Position the patient: Place the patient in the “sniffing position” by flexing the neck and extending the head to optimize airway alignment and visibility.
- Insert the laryngoscope: Gently insert the laryngoscope blade into the mouth at a slight angle, lifting the tongue out of the way to visualize the vocal cords.
- Advance the endotracheal tube: Guide the endotracheal tube through the vocal cords and into the trachea within 15 seconds to minimize oxygen deprivation.
- Remove the laryngoscope and stylet: Once the tube is correctly placed, remove the laryngoscope while holding the tube steady, and carefully extract the stylet. The tube is unstable until secured, so it must be held firmly.
- Inflate the cuff: Inflate the tube’s cuff with 5–10 mL of air to create a secure seal within the trachea.
- Begin manual ventilation: Attach the bag valve mask and manually ventilate the patient, delivering breaths while monitoring for signs of effective ventilation.
- Confirm tube placement: Check for proper tube placement by watching for chest expansion, auscultating for bilateral lung sounds, and using a colorimetric CO2 detector to confirm the presence of exhaled CO2. There should be no breath sounds over the abdomen, indicating the tube is not in the esophagus.
- Secure the tube: Secure the endotracheal tube with tape or a commercially available tube holder to prevent dislodgement.
- Connect to a ventilator: Attach the patient to the ventilator and closely monitor vital signs, ensuring that the chest rises and falls with each mechanical breath.
- Confirm placement with imaging: Obtain a chest radiograph to confirm that the endotracheal tube is correctly positioned within the trachea.
- Ongoing monitoring and adjustments: Continuously monitor the patient’s respiratory status, adjusting ventilator settings as needed to maintain appropriate oxygenation and ventilation.
The intubation procedure is a coordinated effort between physicians, nurses, and respiratory therapists. Its success depends on the availability of proper equipment, a skilled technique, and the practitioner’s experience.
When performed correctly, intubation ensures that the patient’s airway is protected and their breathing is adequately supported.
Risks of Intubation
While intubation is typically a safe and routine procedure, it carries certain risks that should be considered.
Potential complications include:
- Aspiration: The inhalation of stomach contents into the lungs, which can lead to pneumonia or other respiratory issues.
- Vocal cord paralysis: Damage to the vocal cords that may result in temporary or permanent voice changes.
- Hemorrhage: Excessive bleeding that can occur during the procedure.
- Injury to teeth or mouth: Accidental damage to teeth, gums, or lips from the insertion of instruments.
- Throat injury: Trauma to the trachea or surrounding structures, which may cause swelling or discomfort.
- Bleeding: Occurs as a result of tissue injury during intubation.
- Anesthesia risks: Adverse reactions or complications related to sedatives or paralytic agents used during the procedure.
Note: Patients should be closely monitored for any signs of these complications after intubation. This responsibility falls to both respiratory therapists and nurses, who ensure that any issues are promptly identified and addressed to maintain patient safety.
Medications for Intubation
A range of medications are used to facilitate intubation, typically categorized into sedatives and neuromuscular blocking agents. These drugs work together to ensure the patient is calm, pain-free, and that muscle movement is controlled during the procedure.
Commonly used medications include:
- Etomidate
- Ketamine
- Propofol
- Succinylcholine
- Rocuronium
Sedatives are administered to reduce the patient’s level of consciousness and alleviate anxiety, making the process more comfortable and less traumatic.
They help the patient remain calm and unresponsive to the procedure. Examples like etomidate, ketamine, and propofol are fast-acting and allow for quick recovery post-procedure.
Neuromuscular blocking agents are used to induce skeletal muscle paralysis, relaxing the muscles involved in breathing and preventing involuntary movements. This ensures that the airway can be accessed without resistance.
Medications such as succinylcholine (a short-acting paralytic) and rocuronium (longer-acting) are commonly used in rapid sequence intubation to facilitate tube placement.
Note: By using a combination of these medications, clinicians can optimize conditions for successful and smooth intubation while minimizing patient discomfort and complications.
What is Extubation?
Extubation is the process of removing an endotracheal tube from a patient’s airway after it is no longer needed for mechanical ventilation or airway protection. This procedure is typically performed once the patient has regained the ability to breathe independently and can maintain their airway on their own.
Before extubation, medical professionals assess the patient’s readiness by evaluating their respiratory status, oxygen levels, and overall stability. Extubation involves deflating the tube’s cuff, suctioning secretions to clear the airway, and gently removing the tube while monitoring the patient’s response.
Post-extubation care is crucial, as complications such as airway swelling, difficulty breathing, or aspiration may occur. Healthcare providers closely observe the patient’s breathing pattern and oxygen levels to ensure a smooth transition to independent breathing.
Intubation Practice Questions
1. What is the definition of endotracheal intubation?
Endotracheal intubation is the insertion of an endotracheal tube through the mouth or nose into the trachea to secure and protect the airway and provide a connection for mechanical ventilation.
2. What should you do immediately after intubation?
You should verify that the tube is properly placed in the trachea by checking for symmetric chest expansion, auscultating for bilateral breath sounds, and obtaining a chest X-ray to confirm proper positioning.
3. How much pressure should be in the endotracheal tube cuff?
The cuff pressure should be maintained at 15-20 mmHg.
4. What can occur if the cuff pressure is too high?
Excessive cuff pressure can lead to complications such as bleeding, ischemia, or pressure necrosis of the tracheal tissue.
5. What can occur if the cuff pressure is too low?
Insufficient cuff pressure may allow aspiration of secretions, leading to aspiration pneumonia.
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6. How long can a patient be intubated?
Ideally, a patient should not be intubated for longer than 14–21 days. If long-term ventilation is required, a tracheostomy is usually recommended.
7. What are the disadvantages of endotracheal intubation?
Disadvantages include discomfort, reduced cough reflex, thickened secretions, decreased swallowing reflex, increased risk of aspiration, and potential ulceration of the larynx or trachea.
8. What can happen due to the inadvertent removal of an endotracheal tube?
Accidental extubation can lead to laryngeal swelling, hypoxemia, bradycardia, hypotension, and, in severe cases, death.
9. What manual maneuver is used during intubation?
The head tilt, chin lift, and jaw thrust maneuvers are commonly used to open the airway.
10. What are the indications for the head tilt, chin lift maneuver?
This maneuver is indicated in patients without a cervical spine injury and who can protect their own airway, reducing the risk of aspiration.
11. What are the contraindications for the head tilt, chin lift maneuver?
Contraindications include conscious patients and those with known or suspected cervical spine or spinal cord injuries.
12. When is the modified jaw thrust maneuver indicated?
It is used in unresponsive patients with a suspected cervical spine injury to maintain airway patency without moving the neck.
13. When is the modified jaw thrust maneuver contraindicated?
This maneuver is contraindicated in conscious patients.
14. What are the essential components of a bag-valve-mask?
The essential components include a self-refilling bag, mask, oxygen reservoir, and a supplemental oxygen source.
15. What are the disadvantages of bag-valve-mask ventilation?
Disadvantages include gastric distention and difficulty maintaining a leak-proof seal during ventilation.
16. What can be done if the chest is not rising while using a bag-valve-mask for ventilation?
You should reposition the airway, check for any obstruction, lift the jaw, suction the airway, and consider intubation if necessary.
17. What are some reasons for performing intubation?
Indications for intubation include respiratory depression due to drugs, the need to support gas exchange, increasing lung volumes, maintaining a compromised airway, foreign body obstruction, bleeding, edema, trauma, altered consciousness, risk of aspiration, and pre-operative airway management.
18. What are the pieces of equipment needed for intubation?
Necessary equipment includes an oral airway, bag-valve-mask, flowmeter, suction equipment, laryngoscope handle and blades, endotracheal tubes, a 10 mL syringe, stylet, tube tape, stethoscope, and a colorimetric CO2 detector.
19. What laryngoscope blade size should be used in infants?
Blade sizes 0–1 are typically used for infants.
20. What laryngoscope blade size should be used in adults?
Blade sizes 3–4 are commonly used for adults.
21. The laryngoscope blade should reach between what two structures?
The laryngoscope blade should extend between the lips and the larynx.
22. Which type of laryngoscope blade directly lifts the epiglottis?
The Miller blade (straight) directly lifts the epiglottis.
23. Which type of laryngoscope blade indirectly lifts the epiglottis?
The Macintosh blade (curved) indirectly lifts the epiglottis by positioning in the vallecula.
24. What size endotracheal tube is used for males?
Endotracheal tube sizes between 7.5 and 9.0 mm are typically used for males.
25. What size endotracheal tube is used for females?
Endotracheal tube sizes between 7.0 and 8.5 mm are typically used for females.
26. What do the colors mean on a CO2 colorimetric detector?
If the detector turns yellow, it indicates that the patient is exhaling CO2, suggesting the endotracheal tube is likely positioned correctly in the trachea. Remember: “yellow is mellow” and “gold is good.” However, purple signifies a problem, as it means there’s little or no CO2 being exhaled.
27. What are some common errors in intubation technique?
Common errors include improper patient positioning, poor head alignment, incorrect bed height, inadequate leaning over the patient, causing damage to the patient’s teeth, or inserting the tube too deep into the trachea.
28. What is the estimated depth for endotracheal tube placement?
The estimated depth is typically 22 cm for males and 21 cm for females.
29. What are the contraindications for nasal intubation?
Contraindications include nasal fractures, basilar skull fractures, nosebleeds, and sinusitis.
30. What are the complications of nasal intubation?
Complications may include nosebleeds, submucosal dissection, inflammation, edema, and stimulation of the gag reflex.
31. When are the patient’s vocal cords open the most?
The vocal cords are most open during inspiration, making this the best time to advance the endotracheal tube.
32. How can you provide supplemental oxygen to a patient while performing nasotracheal intubation?
Oxygen can be delivered by placing a nasal cannula in the opposite nare, using a face mask over the mouth, or positioning oxygen tubing near the mouth.
33. What are some things to try if the passage of the nasotracheal tube into the trachea is difficult?
If passage is difficult, you can turn the patient’s head to the side, adjust neck flexion or extension, apply cricoid pressure, push the larynx toward the opposite side of the nares, have the patient stick out their tongue, or use a laryngoscope, Magill forceps, or a fiberoptic bronchoscope.
34. What can happen if the patient doesn’t receive enough sedation during intubation?
Insufficient sedation may lead to poor patient cooperation, resulting in trauma, aspiration, and increased difficulty in performing the intubation.
35. What can happen if the patient receives too much sedation?
Excessive sedation can lead to hypoventilation, apnea, cardiac arrest, and the loss of airway-protective reflexes.
36. What two types of drugs are used for sedation?
Narcotic analgesics to relieve pain and sedative/hypnotics to decrease anxiety and induce sleep.
37. What are three examples of narcotic analgesics?
Morphine, fentanyl, and demerol.
38. What is the reversal agent for narcotic drugs?
The reversal agent for narcotics is Narcan (naloxone).
39. What is the most common sedative hypnotic?
The most commonly used sedative hypnotic is Versed (Midazolam).
40. What is the onset and duration of Versed?
Onset: 1–3 minutes; Duration: 20–45 minutes.
41. What produces a temporary loss of sensation or feeling in a confined area of the body?
Local anesthesia provides temporary loss of sensation in a specific area.
42. What are the benefits of rapid induction?
Rapid induction is easier to perform, minimizes side effects associated with awake intubations, causes minimal changes in vital signs, and reduces trauma.
43. What are the side effects associated with awake intubations?
Side effects can include hypertension, tachycardia, and increased bronchospasm due to airway stimulation.
44. What are three adverse effects of rapid induction?
Myocardial depression, hypotension, and increased airway obstruction due to loss of laryngeal muscle tone.
45. What should be monitored during rapid induction?
Monitor the patient’s heart rate and rhythm, respiratory rate and depth, SpO2, skin color, blood pressure, and level of consciousness.
46. How soon should the patient awaken after rapid induction?
The patient should awaken within 10–15 minutes after rapid induction.
47. How do you prepare the patient for rapid induction?
Pre-oxygenate the patient with an FiO2 of 100%.
48. What are the criteria for extubation?
The patient must meet several criteria, including adequate respiratory mechanics, stable vital signs, normal electrolytes, hemoglobin (Hgb), and hematocrit (Hct), adequate urine output (UO), no acute processes, adequate level of consciousness (LOC), stable chest X-ray (CXR), and recovery of airway reflexes and anesthesia.
49. Why is stridor most likely heard when a patient self-extubates?
Stridor is often heard because the cuff is being pulled out while still inflated, causing airway irritation and swelling.
50. What is the treatment for moderate to severe stridor?
Intubation is recommended for moderate to severe stridor to protect the airway and ensure proper ventilation.
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51. What are the two ways intubation can be performed?
Intubation can be performed via orotracheal or nasotracheal routes.
52. What are the complications of intubation?
Complications include trauma to the airway, bleeding, and damage to teeth.
53. What are the contraindications of intubation?
The only true contraindication is if the patient has a living will or advance directive specifying that they do not wish to be intubated.
54. What are the components of an endotracheal tube?
An endotracheal tube consists of the following parts: 15 mm adapter, pilot balloon, cuff, beveled tip, curved body with cm markings, radiopaque line, Murphy eye, and vocal cord line.
55. What is the 15 mm adapter?
The 15 mm adapter connects the endotracheal tube to standard equipment such as a bag-valve-mask or the ventilator circuit.
56. What is the pilot balloon?
The pilot balloon is used to inflate and deflate the cuff and also allows for monitoring of cuff pressure.
57. What is the cuff?
The cuff surrounds the endotracheal tube and creates a seal in the trachea to ensure effective ventilation and to help prevent aspiration.
58. What is the purpose of a beveled tip?
The beveled tip helps minimize trauma during tube insertion.
59. What is the purpose of the curved body with centimeter markings?
The cm markings on the tube’s curved body indicate the depth of insertion and serve as a reference for securing the tube in place.
60. Why does an endotracheal tube have a radiopaque line?
The radiopaque line is visible on a chest X-ray to confirm the position of the tube.
61. What is the Murphy eye of an endotracheal tube?
The Murphy eye is an additional hole near the tube’s tip that serves as a safety feature in case the primary opening becomes obstructed.
62. What is the vocal cord line?
The vocal cord line serves as a marker to indicate when the tube has been inserted far enough, helping to prevent over-insertion.
63. What size ET tube should be used for males?
For males, a size 8.0 endotracheal tube is commonly used.
64. What size ET tube should be used for females?
For females, a size 7.5 endotracheal tube is typically used.
65. What size ET tube should be used for neonates?
The size of the ET tube for neonates is determined by their weight.
66. What is the typical tube position for males?
The typical position for an ET tube in males is 21–23 cm at the lip.
67. What is the typical tube position for females?
The typical position for an ET tube in females is 19–21 cm at the lip.
68. What are the two types of laryngoscope blades?
The two types are the Macintosh (curved) and Miller (straight) blades.
69. What is the Miller blade?
The Miller blade is a straight laryngoscope blade that directly lifts the epiglottis for intubation.
70. What size Miller blades should you use for adults?
For adults, a size 2 or 3 Miller blade is typically used.
71. Where do you aim the Miller blade during intubation?
The Miller blade is inserted directly over the epiglottis to lift it out of the way for visualization of the vocal cords.
72. What is the Macintosh blade?
The Macintosh blade is a curved laryngoscope blade that indirectly lifts the epiglottis by engaging the vallecula.
73. What size Mac blades should you use for adults?
For adults, size 3 or 4 Macintosh blades are typically used.
74. Where do you aim with the Mac blade during intubation?
The Mac blade is inserted into the vallecula, indirectly lifting the epiglottis and exposing the vocal cords.
75. What are the types of laryngoscopes?
There are two types of laryngoscopes: Regular (with a small light bulb), and Fiberoptic (with a fiberoptic light channel for better visualization).
76. What are the methods for confirming the placement of an endotracheal tube?
Methods include using a colorimetric device, capnography, esophageal detection device, chest X-ray, direct laryngoscopy, videoscope/glidescope, bronchoscope, light wand (lighted stylet), checking for a vapor trail, observing chest rise, and listening for bilateral breath sounds.
77. What is the next step after the ET tube is in place?
After the tube is inserted and the laryngoscope is removed, the next step is to remove the stylet, inflate the cuff, and confirm the tube position.
78. How long should an intubation attempt last?
An intubation attempt should not exceed 15 seconds. During the attempt, monitor the patient’s oxygen saturation and be ready to manually resuscitate if needed.
79. What color is good for the colorimetry device?
You want the color to change from purple to yellow, indicating the presence of CO2 and proper tube placement.
80. What is the best way to confirm endotracheal tube placement?
The most reliable way to confirm tube placement is with a chest X-ray.
81. Where should the endotracheal tube be placed?
The tube should be positioned 2–6 cm above the carina.
82. What are the causes of a difficult airway?
Common causes include obesity and mandible malformations.
83. What is a common specialized insertion technique used during intubation?
A common technique is applying cricoid pressure to the throat to prevent regurgitation and improve visibility of the airway.
84. What is the normal endotracheal tube cuff pressure?
Normal cuff pressure is between 25-35 cmH2O.
85. What does the Murphy’s eye protect against?
The Murphy’s eye is an extra hole on the side of the tube that allows air to pass through if the primary opening becomes obstructed.
86. What is the purpose of the stylet?
The stylet provides rigidity to the endotracheal tube, helping guide it into the trachea during insertion.
87. What is the purpose of using lidocaine during intubation?
Lidocaine helps numb the vocal cords, reducing the risk of laryngospasm during intubation.
88. What equipment is needed for extubation?
Equipment needed includes a Yankauer suction device, pulse oximeter, towels, and an oxygen delivery source.
89. What is a common complication of extubation?
A common complication is stridor, caused by swelling of the airway.
90. What is the difference in the intubation procedure for different types of patients?
The procedure itself is similar for all patients, but the size of the equipment varies depending on the patient’s age and size.
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91. Who can perform intubation?
Intubation can be performed by doctors, respiratory therapists, anesthesiologists, nurse anesthetists, and trained EMTs.
92. What is the most common reason for re-intubation?
The most common reason for re-intubation is improper placement of the endotracheal tube.
93. What is an artificial airway?
An artificial airway is a tube inserted into the trachea to maintain breathing and ventilation.
94. What are the types of artificial airways?
Types of artificial airways include endotracheal tubes, tracheostomy tubes, and pharyngeal airways.
95. What should you do if secretions accumulate during intubation?
Perform airway suctioning to clear the secretions.
96. What is glidescope intubation?
Glidescope intubation involves using a videolaryngoscope equipped with a fiberoptic camera to visualize the vocal cords for intubation.
97. What is the primary goal of endotracheal intubation?
The primary goal is to secure the patient’s airway to ensure effective ventilation.
98. What is the purpose of pre-oxygenation prior to intubation?
Pre-oxygenation helps prevent hypoxemia during the intubation process by increasing the patient’s oxygen reserves.
99. What can be inserted after multiple failed intubation attempts?
A laryngeal mask airway (LMA) can be inserted if intubation attempts are unsuccessful.
100. What is the last resort after a failed intubation?
The last resort in a failed intubation is performing a cricothyrotomy to establish an emergency airway.
Final Thoughts
Intubation is a life-saving procedure that serves as a cornerstone of modern medicine, ensuring that patients can breathe when their own respiratory system is compromised.
Although it is a common and highly effective intervention, it requires skilled professionals to perform it correctly to minimize risks.
By understanding the purpose, process, and potential complications of intubation, healthcare providers can be better prepared for situations where this critical procedure is necessary.
Written by:
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Alvarado AC, Panakos P. Endotracheal Tube Intubation Techniques. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
- Alanazi A. Intubations and airway management: An overview of Hassles through third millennium. J Emerg Trauma Shock. 2015.