Intubation

Intubation is a medical procedure, which is aimed to secure the airways. It may be a life-saving intervention.

Indications

It is either performed as an acute intervention, being part of cardiopulmonary resuscitation, or as a planned intervention is surgical interventions when the patient is under general anesthesia. The intubation allows ventilating the patient by a bag valve mask or by an artificial lung ventilator.

Principle

The procedure is performed in patient in horizontal position and the doctor or paramedic stands behind the head of the patient. Special metal retractor with a light source (laryngoscope) is put into the mouth and helps to open it.  It also allows moving the patient's tongue to the side and visualizes the entrance into esophagus and airways (larynx). Under vision control, it is possible to take a special airway tube and insert it into the larynx and trachea. The end part of the tube is equipped by an inflatable balloon, which is inflated by air by a piston from the outside. The inflated balloon stabilizes the tube in the trachea and prevents aspiration of stomach content (or other fluids). The outer part of the tube can be connected to a bag valve mask, or to an artificial lung ventilator.

Complications

The introduction of the tube is particularly difficult in unconscious patients during cardiopulmonary resuscitation. The oral cavity can be full of saliva and vomits, thus significantly reducing local visibility. The tube may be mistakenly inserted into esophagus. Hence, after the introduction of the tube and sealing the balloon, it is advisable to perform few deeper breaths by the bag valve mask and listen to the lung sounds by stethoscope on the back of the chest. When we do not listen the breathing, it is advisable to check the oral cavity and reinsert the tube. When the condition of the patient improves and the tube is removed, the patient may feel sore throat and suffer from hoarseness for some time.

Advantages

The intubation allows us to quickly secure airways of an unconscious person and separate it from digestive tract (i.e. protect from aspiration) by inflation of the balloon. The prevention of aspiration is very important as the gastric content is very aggressive towards the lung tissue and it may cause the so-called Mendelson's syndrome.