What Is Intubation and Why Is It Done?

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Intubation is the process of inserting a tube into the mouth or nose and then into the airway to help move air in and out of the lungs. There are several reasons why it may be performed, but it is mainly used to support breathing during surgery or an emergency.

This article explains the different uses of intubation, how it is performed, and the risks involved.

Intubation

Verywell / Joshua Seong

Uses

When the tube is inserted through the mouth, it is referred to as endotracheal intubation. When it is inserted through the nose, it is known as nasotracheal intubation.

There are a variety of different reasons someone may be intubated, and the method used depends on the purpose.

Endotracheal (through the mouth) intubation is used in most emergency situations. That's because the tube that gets placed through the mouth is larger and easier to insert than the one inserted through the nose.

Endotracheal intubation may be used to:

Nasotracheal (through the nose) intubation is used to:

  • Protect the airway if there is an impending threat of obstruction
  • Deliver anesthesia for surgeries involving the mouth, head, or neck (including dental surgery)

Recap

Endotracheal intubation is typically used in emergencies. It also supports breathing in people with severe breathing problems due to disease or trauma. Nasotracheal intubation is more commonly used to deliver anesthesia, but it can also protect the airways if there is a risk of obstruction.

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This video has been medically reviewed by Rochelle Collins, DO.

Risks

The benefits of intubation tend to outweigh any risks. Even so, there are some that should be considered, especially in people who are on a ventilator for a long period of time.

Common risks include:

  • Gagging or choking
  • Sore throat
  • Hoarseness
  • Bleeding
  • A hole in the esophagus or soft palate
  • Trauma to the teeth, mouth, sinuses, larynx (voice box), or trachea (windpipe)
  • Bacterial infection, such as aspiration pneumonia
  • Damage to soft tissues with prolonged use
  • Inability to be weaned off a ventilator, requiring a surgical procedure to insert a tube directly into the windpipe to assist with breathing (tracheostomy)

Procedures

The process of intubation varies based on whether the tube is inserted into the mouth or nose. Adjustments are also made when children are involved.

Endotracheal Intubation

Prior to intubation, a person is typically sedated or unconscious due to trauma. The process follows the same basic steps:

  1. The person is laid flat on their back.
  2. The health provider positions themselves above the person's head looking down at their feet.
  3. The person's mouth is opened. A guard may be inserted to protect the teeth.
  4. With the help of a lighted instrument that also keeps the tongue out of the way, the tube is gently guided into the throat and advanced into the airway.
  5. A small balloon at the end of the tube is inflated to secure it in place and keep air from escaping.
  6. The tube on the outside of the mouth is secured with tape.
  7. The tube can then be connected to a ventilator or used to deliver anesthesia or medications.
  8. The healthcare provider will check that the placement is correct with a stethoscope, a chest X-ray, and/or a tool called a capnograph that detects carbon dioxide exhaled from the lungs.

Nasotracheal Intubation

The process of nasotracheal intubation is similar to endotracheal intubation, but the person may either be fully or partially sedated. Since nasal intubation is more often performed in a controlled environment, there may be other tools involved in the process.

This includes the use of a decongestant spray to prevent nosebleeds, a topical anesthetic to reduce pain, and a muscle relaxant to prevent gagging. Some providers will also widen the passage with a device called a nasal trumpet.

Once the tube is fed into the nostril and enters the middle part of the throat, a fiberoptic scope (called a laryngoscope) helps guide the tube between the vocal cords and into the windpipe. The tube is then inflated to secure it in the trachea and taped on the outside to keep it from moving.

Intubating Children

The process of intubation is more or less the same for adults and children, aside from the size of the tube and some of the equipment used.

Newborns can be especially difficult to intubate, not only because of their smaller size but because their tongues are proportionally larger and the passage into the windpipe is proportionately longer and less flexible. Nasal intubation is the preferred method for newborns and infants. Still, it can take several attempts to place the tube.

Recap

Intubation involves the insertion of a tube through the mouth or nose, which is then secured in the windpipe with an inflatable balloon. This can be done in both adults and children, although it may take several attempts in newborns.

Feeding During Intubation

If an intubated person needs to be on a ventilator for two or more days, tube feeding will typically start a day or two after the tube is inserted. This is referred to as enteral nutrition.

Because it isn't possible to take food or fluids by mouth while intubated, tube feeding may be delivered in one of two ways:

  • Orogastric (OG): Using a tube that passes through the mouth and into the stomach
  • Nasogastric tube (NG): Using a tube that passes through a nostril and into the stomach

Medication, fluids, and nutrition can then be pushed through using a large syringe or pump.

For other people, nutrition may be given intravenously (via a needle in the arm). Also known as total parenteral nutrition (TPA), this is an option for people with severe malnutrition and weight loss, as well as those with a blockage in the intestine or diseases that make tube feeding impossible.

Tube Removal

Extubation is the process of removing a tracheal tube. When it is time to do so, the tape that holds the tube in place is removed.

Next, the balloon that holds the tube in the airway is deflated and the tube is gently pulled out.

Once the tube is out, you may have to work to breathe on your own, especially if you have been on a ventilator for a long time.

Coughing, hoarseness, and discomfort are common, but these tend to improve with a few days.

Recap

Those on a ventilator for two or more days can receive nutrition and fluids through a tube that leads to the stomach. Everyone who is intubated will eventually have their tube removed. Some may simply be uncomfortable afterward; others may need to work on resuming breathing normally again.

Summary

Intubation is the insertion of a tube either through the mouth or nose and into the airway to aid with breathing, deliver anesthesia or medications, and bypass a blockage.

It is called endotracheal intubation when the tube is inserted into the mouth and a nasogastric tube when the tube is fed through a nostril. The procedure for both is largely the same. Once the tube is fed into the windpipe, a balloon at the end of the tube is inflated to secure its position and prevent air from escaping.

There are risks associated with intubation, including vomiting and accidental puncture, but the benefits generally outweigh the risks in emergency situations and during surgery.

A Word From Verywell

It is common to be intubated and placed on a ventilator if general anesthesia is used for surgery. While these things may seem scary, most people experience only mild side effects like sore throat and hoarseness once the tube is removed. Some people have no symptoms.

If you feel anxious about being placed on a ventilator, discuss this with your surgeon or anesthesiologist who can walk you through the procedure. They may also be able to give you a mild sedative to help ease the stress.

Frequently Asked Questions

  • What does DNI mean?

    DNI stands for "do not intubate." If someone planning on having surgery decides that they do not want to be placed on a ventilator if one is needed, this wish will be noted on their medical record so that healthcare providers do not take this measure.

  • Can you be awake on a ventilator?

    Being awake on a ventilator is possible, but people are usually sedated to prevent anxiety or discomfort. When a person is placed on a ventilator, they may be given monitored anesthesia to induce "twilight sleep" or general anesthesia to put them fully asleep.

  • How long can someone be intubated?

    Most people who are intubated stay on a ventilator for a matter of hours, days, or weeks. However, people on life support or those with chronic hypoventilation due to severe neuromuscular disorders and other conditions may be on a ventilator for months or years.

  • What does extubation mean?

    Extubation is the removal of a breathing tube. If the person no longer needs assisted breathing, the tubes are removed from the windpipe and mouth or nose as soon as possible.

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11 Sources
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