Treatments & Therapies

Endotracheal Intubation – Treatment, Effect & Risks

Endotracheale Intubation

Endotracheal intubation is used to ventilate unconscious or anesthetized patients in rescue and accident medicine as well as in anesthesia . An endotracheal tube is used, which is inserted into the trachea through the mouth or nose . Improper intubation can lead to complications.

What is endotracheal intubation?

Endotracheal intubation is the standard method for artificial ventilation of emergency patients and anesthetized patients. This method is also referred to as intubation. The basis of this procedure is the insertion of an endotracheal tube into the windpipe (trachea) through the nose or mouth.

It is passed between the vocal folds of the larynx . The endotracheal tube consists of a plastic tube for the oxygen supply. It usually also contains a so-called cuff, which is inflated to prevent foreign bodies from being aspirated into the lungs .

There are tubes with two lumens (double lumen tube). You are able to ventilate both lungs separately. If intubation is difficult, alternatives to endotracheal intubation are used in the form of laryngeal masks, laryngeal tubes, and combination tubes.

Function, effect & goals

Endotracheal intubation is used in patients who are unable to breathe on their own due to disease, inadequate reflexes, or anesthesia. Intubation prevents obstruction of the upper airway and aspiration of foreign objects into the lungs.

It works by inserting an 8 to 12 inch (20 to 30 cm) tube (a hollow plastic tube) through your mouth or nose, through your larynx and into your trachea (windpipe). A connector for the ventilator is attached to the mouth end of the hose. At the other end, the hose is slightly bevelled. A so-called cuff is located just in front of it. This cuff can be inflated as a balloon and blocks the trachea from the nasopharynx to prevent inhalation of foreign bodies such as blood , vomit or other.

When the balloon is inflated, the gaps between the tube and the wall of the trachea close. Before the tube is inserted, the patient is positioned in the so-called Jackson position. The head is high and the neck is overstretched. This creates the best view of the glottis through the mouth. Using the blade of a laryngoscope, the epiglottis is pulled caudally and upwards. The tube is pulled through the vocal folds until the cuff has crossed them. The cuff is then inflated and the patient is listened to.

If everything is correct, ventilation can be continued. Endotracheal intubation is used in a variety of situations. The protective reflexes during breathing no longer function in patients with cardiovascular arrest, anesthetized patients or patients with severe poisoning. Your ventilation is urgently needed. Patients with insufficient breathing often also require artificial ventilation. In addition, artificial ventilation is often necessary for bronchoscopy , endoscopic operations on the respiratory tract, injuries to the upper respiratory tract or allergies to insect bites.

Depending on the area of ​​application, different endotracheal tubes are also used. There are flexible or rigid tubes. Most tubes have an inflatable cuff. However, this does not apply to everyone. The cuff can lead to necrosis if it lies on the mucous membrane for too long , so that cuffs are often not used for long-term ventilation. A cuff is also not used in children because their mucous membrane swells so quickly that the sealing of the trachea is already secured.

A spiral tube does not kink so easily and is therefore often used in goiter operations. Endotracheal intubation requires a great deal of experience and is therefore difficult for many physicians to use. For this reason, many clinics have a special team for resuscitation .

Risks, side effects & dangers

Various complications can occur when performing endotracheal intubation, especially since many physicians lack experience in this field. A common complication is incorrect intubation of the esophagus , which can even be fatal. In this case, the stomach is ventilated instead of the lungs .

If the error is not recognized in time, the patient will die from asphyxiation. It is therefore standard today to carry out a monitoring that is intended to avoid this incorrect intubation. The so-called aspiration is also feared. Foreign bodies such as blood or stomach contents enter the lungs via the trachea. If there is an increased risk of this aspiration, a special form of anesthesia induction (rapid sequence induction) is carried out, which results in the accelerated induction of anesthesia . Another complication is injury to the vocal cords .

If the tube is advanced too far, there is a risk that only one lung will be ventilated. This incorrect intubation can be detected quickly by listening. The correction is made quickly by withdrawing the tube. Long-term ventilation can have negative effects on the tracheal mucosa. Necrosis and ulcers may occur as a result of the pressure on the mucous membrane. Therefore, the cuff pressure in intensive care units must be constantly monitored.

In rare cases it can happen that the teeth break out of the upper jaw . Very rarely, a reflex cardiac or respiratory arrest is possible due to the irritation of the parasympathetic nervous system. Insufficient anesthesia during intubation can also lead to vomiting. For this reason, it is important that the patient remains sober before a planned anesthetic.

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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.