• Diseases&Conditions
• Procedures & Tests
• Injuries & Symptoms
• Special Topics
• Nutrition

Endotracheal intubation is the insertion of a tube through the nose or mouth into the windpipe (trachea).

Who is a candidate for the procedure?

• keep the airway open, such as while cardiopulmonary resuscitation (CPR) is being performed
• give a person general anesthesia or oxygen
• remove secretions

Intubation is needed:

• when a person does not have enough oxygen in his or her blood
• when a person cannot breathe properly or has too much carbon dioxide in the blood. Carbon dioxide is normally breathed out when a person exhales if the lungs are working properly. When too much of it builds up, it is toxic to the body.
• when secretions must be removed from the lungs or controlled. This may be necessary, for example, when a person has severe lung disease.
• to protect the airway in a person whose gag reflex is depressed, which makes lung infections more likely. This might be needed after a head injury, for example, or a neurological injury that affects the respiratory system.
• during general anesthesia for surgery

How is the procedure performed?

• the person will be given oxygen through a special face mask
• he or she will be sedated, if possible. Medication that relaxes the person may be given along with another medication that paralyzes the muscles in the body for a short period of time.
• a special suction device will be available to remove secretions from the mouth

The intubation may be done through the mouth or nose, using one of the following methods:

• A tube is inserted through the mouth, past the vocal cords into the trachea. A lighted tool called a laryngoscope is used to examine the throat and make sure the tube goes in properly. The neck is positioned with the head back to make the opening between the vocal cords as easy as possible to see.
• A tube is inserted through the nose and into the trachea. This is done blindly without the use of a laryngoscope to see the windpipe opening. Because this technique does not require special positioning of the neck, it is useful when the patient has a neck injury.

What happens right after the procedure?

Once the tube has been inserted:

• it is attached to a bag that can be squeezed to deliver breaths to the person, until a ventilator can be connected to the tube, if needed
• its placement will be checked by listening for airflow sounds over the lungs
• a chest X-ray will be taken to confirm that the tube is in the right place
• an arterial blood gas test may be done to check for proper levels of oxygen and carbon dioxide
• the person may be sedated

A person who has been intubated cannot talk.

What happens later at home?

A person must stay in the hospital until the tube is removed. Once it has been removed, he or she may have a sore throat due to irritation from the tube.

What are the potential complications after the procedure?

Intubation may cause complications. Some possibilities are:

• esophageal intubation, which occurs when a tube is put into the esophagus or food tube by mistake, instead of into the trachea. To keep this from happening, the healthcare professional who has done the intubation listens with a stethoscope over the stomach while giving oxygen to the person through the tube. If airflow sounds are heard over the stomach or the stomach swells up, the tube is in the esophagus. It must be removed promptly and a new tube placed properly in the trachea.
• intubation of the right mainstem bronchus. This occurs, especially in smaller individuals, when the tube is inserted too far into the trachea. The result is that the tube goes past the "fork" toward the right lung, and only the right lung is ventilated. The problem can be detected if the professional hears no breath sounds on the left side, and can be fixed by simply pulling the tube back a centimeter or two.
• swelling at the back of the throat
• vocal cord injury
• damage to the trachea, including a hole
• damage to teeth
• lung infection such as pneumonia
• spasm of the muscles of the windpipe, which may cause pain and difficulty breathing