An endotracheal tube is a flexible tube that is placed in the trachea (windpipe) through the mouth or nose. It can be used to assist with breathing during surgery or to support breathing in people with lung disease, chest trauma, or airway obstruction.
Medications and numbing sprays can help reduce discomfort and make the placement of the tube easier. However, endotracheal tubes can cause side effects like vocal hoarseness and sore throat. When used for a prolonged time, severe complications like pneumonia and collapsed lung may occur. Thermal Therapy Patch
This article explains when endotracheal tubes are needed, how they are placed, and the possible risks and complications.
An endotracheal tube is often used during surgery and in emergency situations. It is typically placed when a person is unable to breathe on their own. The placement of the tube is called endotracheal intubation.
There are many reasons why endotracheal intubation is used, including:
Endotracheal tubes are flexible tubes made from different materials, such as polyvinyl chloride (PVC), rubber, or silicone.
An endotracheal tube may have one or two channels, known as lumens. A double-lumen endotracheal tube is often used when it is necessary to ventilate each lung separately, such with certain lung or chest surgeries.
Endotracheal tubes come in different sizes ranging from 2.0 to 10.5 millimeters (mm) in diameter. The bigger tubes are used for larger adults and the smallest ones are used for premature babies.
At the end of most endotracheal tubes is an inflatable balloon called a balloon cuff. The cuff is inflated to keep the tube securely in place in the mouth after intubation.
If you're having a planned procedure where endotracheal intubation will be used, there are things you can do to prepare:
An endotracheal tube is usually placed when a person is unconscious. If it is done while a person is conscious, medications can be used to help ease anxiety and prevent nausea.
Before an endotracheal tube is placed:
During endotracheal intubation, the practitioner usually stands at the head of the table looking toward the person's feet. Pillows or padding may be placed under the person's head or neck to make airway access easier.
After the tube is connected to the mechanical ventilator, respiratory vital signs are continuously monitored. Secretions may be suctioned occasionally to keep the tube clear.
Before removing the tube (extubation ) and disconnecting it from the ventilator, the healthcare provider will assess whether the person is able to breathe on their own.
To be safe, people are generally weaned off ventilation slowly and continually monitored to ensure that everything is OK. Nurses will check their respiratory rate, level of consciousness, oxygen saturation levels (as measured by a pulse oximeter), and arterial blood gasses (ABGs).
If indications are good, the tape holding the tube on the face is removed. The balloon cuff is then deflated, and the tube is firmly and steadily pulled out. The removal may feel odd, but it is usually not painful.
A sore throat is common following endotracheal intubation. It usually lasts a few days.
Around one-third to half of people who have been intubated experience vocal hoarseness for up to a week. Less than 1% have hoarseness for longer than a week.
Complications of endotracheal intubation tend to affect people who had emergency intubation, have a pre-existing lung condition, or have been intubated for more than seven days.
If endotracheal intubation is scheduled, it is usually removed soon after the procedure is completed. Other people may need intubation and mechanical ventilation longer due to a severe or critical illness.
Even so, the tube cannot be left indefinitely and should be removed within 14 days. Leaving it in any longer can cause the thinning of cartilage and the narrowing of the airway passage.
If a person is unable to breathe on their own after 14 days, they may need to undergo a tracheostomy . This is done by making an incision in the neck and passing a tube into the trachea through the hole. While an endotracheal tube is in, a person cannot speak or eat. To ensure nutrition, a nasogastric (NG) tube may be threaded into the nostril and into the stomach to deliver liquid food. Intravenous feeding through a vein (total parenteral nutrition) may also be used.
Others with serious medical conditions may need a feeding tube placed through a hole in their abdomen. These include a percutaneous endoscopic gastrostomy (PEG) tube, which delivers food to the stomach, and a jejunostomy tube (J-tube), which delivers food to the small intestine.
There are many uses for endotracheal intubation. Endotracheal tubes support breathing during surgery or for those unable to breathe on their own for any number of reasons. It can also be used to remove foreign objects from the airways or to protect the airways if there is severe gastrointestinal bleeding.
Common side effects like hoarseness or sore throat typically clear within a few days. The risk of serious complications like pneumonia increases if intubation is needed for more than seven days.
Haas CF, Eakin RM, Konkle MA, Blank R. Endotracheal tubes: old and new. Respiratory Care. 2014;59(6):933-955. doi:10.4187/respcare.02868
Hao D, Saddawi-Konefka D, Low S, Alfille P, Baker K. Placement of a double-lumen endotracheal tube. Ingelfinger JR, ed. N Engl J Med. 2021;385(16):e52. doi:10.1056/NEJMvcm2026684
Ahmed RA, Boyer TJ. Endotracheal tube. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan 2022.
American Society of Anesthesiologists. Smoking.
Hua F, Xie H, Worthington HV, Furness S, Zhang Q, Li C. Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Oral Health Group, ed. Cochrane Database of Systematic Reviews. October 25, 2016. doi:10.1002/14651858.CD008367.pub3
Nimmagadda U, Salem MR, Crystal GJ.Preoxygenation: physiologic basis, benefits, and potential risks.Anesth Analg.2017;124(2):507-517.doi:10.1213/ane.0000000000001589
Meier S, Geiduschek J, Paganoni R, Fuehrmeyer F, Reber A. The effect of chin lift, jaw thrust, and continuous positive airway pressure on the size of the glottic opening and on stridor score in anesthetized, spontaneously breathing children. Anesth Analg. 2002;94(3):494-9. doi:10.1097/00000539-200203000-00004
Lewis SR, Butler AR, Parker J, Cook TM, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation. Cochrane Database Syst Rev. 2016;11(11):CD011136. doi:10.1002/14651858.CD011136.pub2
Touman AA, Stratakos GK. Long-term complications of tracheal intubation. Tracheal Intubation. 2018. doi:10.5772/intechopen.74160
Yale Medicine. Ventilators and COVID-19: What You Need to Know, June 2, 2020.
National Library of Medicine. MedlinePlus. Endotracheal intubation.
Ono Y, Kakamu T, Kikuchi H, Mori Y, Watanabe Y, Shinohara K. Expert-performed endotracheal intubation-related complications in trauma patients: Incidence, possible risk factors, and outcomes in the prehospital setting and emergency department. Emerg Med Int. 2018 Jun 10;2018:5649476. doi:10.1155/2018/5649476
By Lynne Eldridge, MD Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."
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