Intubation is the process of placing a tube called endotracheal tube (ET) through the mouth and then into the airway. This procedure is performed to place the patient in a ventilator to help the patient breathe during anesthesia, sedation or severe illness. This tube then connects to the ventilator device that pushes the air towards the lungs for the patient to breathe. Intubate is done because the patient cannot protect the airway, can not breathe on his own without help, or both are made. Patients who will be intubated are usually sick or injured enough to undergo anesthesia, not be able to breathe on their own during surgery, or provide adequate oxygen to the body without help.
Purpose of Intubated
When general anesthesia is given, intubation is required. Anesthesia drugs paralyze the muscles of the body, including aperture, making breathing impossible without a ventilator. Most patients are excised, meaning that the respiratory tube is removed immediately after surgery. If the patient is very ill or has difficulty breathing on its own, it can remain in the ventilator for longer. After most procedures, a drug is given to reverse the effects of anesthesia, allowing the patient to wake up quickly and start breathing on his own.
For some procedures, such as open heart procedures, the patient is not given medication to reverse anesthesia and wakes up slowly on its own. These patients need to stay in ventilators until they wake up enough to maintain their airways and breathe on their own. Intubation is also performed for respiratory failure. There are many reasons why a patient is too ill to breathe enough on their own. He may experience respiratory problems such as damage to his lungs, severe pneumonia, Kovid or COPD. If a patient can’t get enough oxygen on its own, a ventilator may be necessary until it’s strong enough to breathe without help.
Most intubation procedures involve very low risk, but if the patient has to stick to the ventilator for a long time, there may be some potential problems that may arise. Common risks include:
• Trauma in the teeth, mouth, tongue and/or larynx
• Inadvertent intubation in the esophagus (food tube) instead of trachea (air tube)
• Trachea trauma
• Inability to leave the ventilator requiring a tracheostomy.
• Intubated, astubation (inhalation) vomit, saliva or other liquids
• Pneumonia, if it is aspiration
• Sore throat
• Soft tissue erosion (with long-term intubation)
The medical team assesses these potential risks and will do everything they can to address them.
Before intubation, the patient is typically calmed, not aware of it due to illness or injury, which allows the oral and airway to loosen. The patient typically lies on his back and is in a position that looks at the foot. The person who will place the tube stops by the bed and asks the patient to open his mouth gently. With the help of a light used to illuminate the throat, it is inserted into the intubated and advanced towards the airway. Around the tube, there is a small balloon that is inflated to keep the tube in place and prevent the air from escaping. This balloon in the tube is inflated and the tube is taped into the mouth after it is safely placed in the airway.
To successfully place the intubation, the lungs are first controlled by resting with a stethoscope and are usually confirmed by a chest X-ray. In the field or in the operating room, a device that measures carbon dioxide is used to verify that it is placed correctly – only if the tube was in the lungs instead of the esophagus.
In some cases, if the mouth or throat is operated or injured, the respiratory tube is passed through the nose instead of the mouth called nasal intubation. The nasotrachealtube (NT) goes into the nose, down from the back of the throat and into the upper respiratory tract. This is done to keep the mouth empty and to ensure that the surgery is performed. This type of intubation is less common, because it is often easier to intubate using wider mouth openness and is not necessary for most procedures.
The intubation process is the same as adults and children, except for the size of the equipment used during the process. A small child needs a tube much smaller than an adult, and placing the tube may require a higher degree of sensitivity because the airway is much smaller. In some cases, a fiberoptic scopy, a tool that allows the person who inserts the windpipe to monitor the process on the monitor, is used to facilitate intubation.
The actual placement of the tube is essentially the same for adults as well as for older children, but nasal intubation is preferred in newborns and infants. Preparing the child for surgery is very different from the adults’. While an adult may have questions about insurance coverage, risks, benefits and recovery times, a child needs a different explanation of the process. Assurance is required and emotional preparation for surgery will vary depending on the age of the patient.
Nutrition During Intubation
It will be in the ventilator for a procedure and then does not require feeding a patient to be excised when the procedure is completed, but you can take fluid through an IV. If a patient is expected to depend on ventilators for two or more days, nutrition typically starts a day or two after intubation. It is not possible to take food or liquid from the mouth when intubated.
A tube is placed in the stomach from the throat to make it possible to safely take food, medicines and fluids from the mouth. This tube is called orogastric (OG) when inserted into the mouth or nasogastric tube (NG) when inserted into the nose and throat. Medications, fluids and tube feeding are then pushed through the tube and into the stomach using a large syringe or pump. Food, liquids and medicines should be given intravenously for other patients. IV feeds, called TPA or total parenteral nutrition, provide nutrition and calories directly into the bloodstream in liquid form. Since nutrients are best absorbed from the intestines, such feeding is typically avoided unless absolutely necessary.
Removal of the Respiratory Tube
Removing the tube is much easier than placing it. When the time comes to remove the tube, the ligaments or bands that hold it in place must be removed first. The balloon, which then holds the tube in the airway, is then extinguished so that the tube can be gently pulled. After the tube is removed, the patient will have to do his own breathing work. The need to be intubated and placed in a ventilator is common in general anesthesia, which means that most surgeries require this type of care. While it is scary to think about being in a ventilator, most surgical patients begin to breathe on their own a few minutes after the end of the surgery. If anyone has concerns about using ventilators for surgery, it is advisable to openly discuss their concerns with the person who provides the surgeon or anesthesia.