What Is Intubation & When Is It Necessary?

Key Takeaways

Intubation is a life-saving procedure when someone is unable to breathe on their own. A healthcare provider inserts a tube through a person’s mouth or nose, to keep the airway open. The tube can be connected to an artificial breathing machine called a ventilator.
There are several different types of intubation practices that are used based on the patient’s presentation, the reason for the endotracheal intubation, and the clinical setting.
People typically stay intubated for a few hours, days, or weeks and are removed from the tubes once breathing improves. Most people have a quick recovery after intubation. However, complications can sometimes arise.

Intubation is a medical procedure that is usually performed in emergency situations in critically ill patients or before surgeries in the hospital. An emergency intubation can be a life-saving procedure when someone is unable to breathe on their own. Please continue reading to learn more about how and why endotracheal tubes are inserted.

What is endotracheal intubation?

Endotracheal intubation, also called tracheal intubation or intubation, is a procedure in which healthcare providers insert a tube called an endotracheal tube through a person’s mouth or nose, guide it past the voice box and into the trachea (windpipe or upper airway). The placement of the intubation tube helps to keep the airway open. The endotracheal tube tip can be connected to an artificial breathing machine called a ventilator. If mechanical ventilation is not possible, the tube inserted in the trachea can be connected to a squeezable bag, which can be used to push air into and out of the lungs.

Why would someone need to be intubated?

Endotracheal tube placement is needed when the airway is damaged or blocked and spontaneous breathing is interrupted. Some common reasons for needing endotracheal intubation include:

A foreign object obstructing (blocking) the airway.
Swelling and narrowing of the airway, for example, due to a severe allergic reaction.
Stopping breathing due to cardiopulmonary arrest (abrupt loss of heart and lung function).
Loss of consciousness without adequate airway control.
Severe trauma to the neck, chest, or abdomen causing damage to the airway.
Urgent surgical procedures that will make spontaneous breathing impossible.
Apnea (temporary stopping of breathing) or respiratory failure.
Risk of aspiration (inhaling food, blood, vomit, or other fluids).

What are the different endotracheal tube intubation techniques?

The intubation practices used depend on the patient’s presentation, the reason for the endotracheal intubation, and the clinical setting (emergency department, critical care unit, or operating room).

Orotracheal intubation

This is the preferred technique in most clinical settings. The endotracheal tube is inserted through the mouth into the trachea to support breathing. This is done using an instrument called a laryngoscope that provides direct visualization of the voice box, vocal cords, and other structures. Orotracheal intubation can be done faster than nasal intubation and is the preferred method in apneic patients who have stopped breathing as well as critically ill adults.

Nasotracheal intubation

This technique involves passing the endotracheal tube through the nose into the nasopharyngeal airway and trachea. It is commonly used after general anesthesia in the operating room.

Rapid sequence intubation

This technique is used for emergency airway management when the patient may have a full stomach and a risk of aspiration (breathing in a foreign object such as food). It is associated with higher first-attempt intubation success in emergency settings and involves the use of short-acting medications such as sedatives and paralytic agents.

Direct sequence intubation

This intubation technique is used when pre-oxygenation is not possible due to a person’s altered mental status or combativeness.

Note: Healthcare professionals choose the appropriate endotracheal tube size based on age, gender, and neck size. They have alternate techniques available for tracheal placement in people with difficult airways. Emergency cricothyrotomy is the last resort (this involves inserting a tube directly into the trachea through an incision in the cricothyroid membrane). During a cardiac arrest, intubation attempts are made without stopping chest compressions.

Is being intubated the same as being on a ventilator?

Being intubated is not exactly the same as being on a ventilator, but the two are related. Intubation is the procedure in which an endotracheal tube is inserted into the trachea (windpipe or airway). This tracheal tube is then connected to a device or machine that delivers air or oxygen to the lungs. It can be a squeezable bag that is used to push air into the lungs or a mechanical ventilator (artificial breathing machine) that blows oxygen into the lungs. Non-invasive mechanical ventilation can be done using a continuous positive airway pressure (CPAP) machine (this does not require placement of an endotracheal tube).

Is intubation the same as life support?

Most people stay intubated for a few hours, days, or weeks. The endotracheal tube is removed once breathing improves. People on life support might need to stay on a mechanical ventilator for months or even years.

How serious is being intubated?

Endotracheal intubation is a generally safe and common procedure that can deliver oxygen, support breathing, and save a person's life when they cannot breathe on their own. Most people have a quick recovery after intubation, usually within days. However, complications can sometimes arise after endotracheal intubation.

What are the complications of tracheal intubation?

Possible complications of endotracheal intubation include:

Aspiration (breathing in blood, vomit, food, or other substances).
Mainstem intubation (left or right mainstem bronchus intubation) where the endotracheal tube goes into one of the bronchi or main airways connected to the trachea.
Esophageal intubation (where the tracheal tube enters the esophagus (food pipe). This can cause damage to the brain and may be fatal if it is not diagnosed quickly.
Failed intubation (where intubation is unsuccessful and healthcare providers are unable to support breathing).
Tension pneumothorax (where the air gets trapped in the chest cavity, causing the collapse of the lungs).
Injuries to the tongue, teeth, vocal cords, or airway during the intubation procedure, causing pain, swelling, and bleeding.
Infections, including sinus infections, can develop after tracheal intubation.
Anesthesia-related risks.

Frequently Asked Questions

Are you in ICU if you are intubated?

Endotracheal intubation is frequently performed in critically ill patients who are in the intensive care unit (ICU). Emergency intubation may be performed by experts in emergency medicine in the ED.

Can intubated patients be awake?

Most people are sedated before endotracheal intubation. However, an awake intubation may be performed for an anticipated difficult airway.

Does intubation cause permanent damage?

Intubation does not usually cause permanent damage, but sometimes adverse peri-intubation events can cause lasting problems. Minor side effects such as swelling, soreness, sore throat, and difficulty speaking or swallowing are common after the endotracheal tube is removed.

Is it painful to be intubated?

Most people are not awake during intubation. If it is an awake intubation, a healthcare provider can use a topical anesthetic (numbing spray) and sedating medications to make the procedure more comfortable.

How soon can intubation be removed?

Intubation can be removed as soon as you can breathe on your own. Sometimes, the intubation is removed immediately after a surgical procedure once you can breathe on your own. In other cases, the breathing tube needs to stay in while you recover from surgery.

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