Intubation is primarily intended to allow patients who are unable to breathe on their own to breathe. This involves inserting a plastic tube into the trachea through the mouth or sometimes through the nose using a laryngoscope. What are the indications for intubation? How does it run and what are the complications?

Tracheal intubationinvolves inserting a plastic tube into the trachea using a laryngoscope. Properly placed tracheal tube ensures patency of the airways, enables the delivery of oxygen-containing air to the lungs and protects the patient against aspiration of food contents. There is a cuff on the tracheal tube, which seals the space between the trachea and the tube, which enables effective lung ventilation, both with the help of a ventilator and a self-inflating bag. This procedure requires general anesthesia of the patient, as it is very painful.

Contents:

  1. Intubation - indications for intubation
  2. Intubation - how to do it
  3. Oral intubation
  4. Nasal Intubation
  5. Intubation - control of the position of the tracheal tube
  6. Fast intubation
  7. Difficult intubation
  8. Retrograde intubation
  9. Intubation - complications after intubation
  10. Exstubation

Intubation - indications for intubation

The indications for intubation areProviding a replacement breathu:

  • patients who cannot oxygenate with a face mask
  • patients undergoing surgeries under general anesthesia that require mechanical ventilation, muscle toning, or activities in the neck and respiratory tract
  • patients with acute respiratory failure requiring treatment with the use of emergency breathing
  • patients undergoing CPR

It is worth remembering that each unconscious patient should be intubated, with a consciousness score on the Glasgow scale

Intubation - how to do it

The equipment necessary for intubation is an endotracheal tube and a laryngoscope. A guide, forceps, and an oropharyngeal tube may also be useful. There are two ways of tracheal intubation, through the mouth and through the nose. The procedure is performed much more oftenby putting the tube through your mouth. The tube size should be selected individually for each patient, based on, among others, gender, age and anatomy of the body.

Oral intubation

In oral intubation ( orotracheal intubation ), a well-chosen tube is placed under visual control in the patient's airway, more precisely in the trachea, between the vocal cords. An indispensable tool for this procedure is the laryngoscope, i.e. the laryngeal speculum. The end of the endotracheal tube should be in a well-defined place, behind the vocal cords and above the bifurcation of the trachea. The treatment ends with filling the cuff sealing the tubing with air from the syringe.

Nasal Intubation

Nasal intubation ( naso-tracheal intubation ) is performed in newborns and during oropharyngeal surgery. The tubes used are narrower, longer and more curved than those used for oral intubation. During this procedure, a properly selected tube is inserted through the nose into the nasopharynx, and the laryngoscope is only reached when the tip of the tube in the throat is visualized. After that, the procedure is continued as in the case of oral intubation, and the tube is held and placed in the trachea with the help of special intubation forceps.

Contraindications for this procedure are fracture of the skull base, nasal fracture, polyps in the nose and blood coagulation disorders.

Intubation - control of the position of the tracheal tube

The correct position of the tube should be checked using a stethoscope by auscultating and viewing the chest. A breathing noise over the lung fields should be heard equally on both sides and the chest should move symmetrically. You should also make sure that the tube is not in the esophagus by auscultating the stomach. More and more often, to assess the correct placement of the endotracheal tube, a capnographic recording is used, in which we observe the curve of carbon dioxide content in the patient's exhaled air.

Fast intubation

Rapid intubationis performed in patients who are at high risk of aspiration of gastric contents when inserting an endotracheal tube, resulting in aspiration pneumonia or death. High-risk patients include obese people, pregnant women, patients with gastrointestinal obstruction, and people with a full stomach. Such intubation is also performed when it is necessary to undergo an emergency surgery, which the traumatized patient could not attend toprepare properly, i.e. remain on an empty stomach for a specified period of time.

Rapid intubation is based on oxygenation of the patient, administration of drugs inducing anesthesia (etomidate of choice) and short-acting muscle relaxants (suxamethonium). Remember to compress the cricoid cartilage of the larynx when inserting the tracheal tube (Sellick's maneuver). This maneuver causes the esophagus to be constricted, preventing the ingestion of food into the patient's respiratory tract and its aspiration.

Difficult intubation

Difficult intubationis by definition intubation which takes more than 10 minutes, or when an experienced anaesthesiologist tries to perform it unsuccessfully three times. Difficulties in performing the procedure may result from the patient's inherent anatomical features, his teeth, facial and neck injuries, too shallow general anesthesia, insufficient muscle relaxation and the lack of appropriate and efficient equipment.

In such cases, the doctor may decide to use other methods of opening the patient's airways, such as using a fiberscope, laryngeal mask airway device or Combitube tube. In exceptional cases, most often in the case of injuries of the facial part of the skull, when it is impossible to intubate the patient through the mouth or through the nose, and it requires a replacement breathing, the doctor may decide to use surgical methods of opening the airway, such as cricothyroidism, i.e. incision of the cricothyroid ligament larynx. It enables the insertion of the endotracheal tube into the trachea and ventilation of the patient's lungs.

Retrograde intubation

Retrograde intubationis an extremely rare procedure. It consists in puncturing the skin, subcutaneous tissue and cricothyroid ligament and inserting it through the resulting opening of the guide directly into the larynx. The guide advances towards the mouth, threads the tracheal tube over it, and then slides the tube blindly over it into the trachea. This procedure does not require the use of a laryngoscope. After the tracheal tube is placed in the correct place in the airway, the guide is removed.

Intubation - complications after intubation

The most common complications after endotracheal intubation include:

  • tooth damage
  • unintentional esophageal intubation
  • intubation of one bronchus with atelectasis of an unventilated lung

That is why it is so important to carefully check the correct position of the tube before inflating the cuff with air. The less common complications include:

  • patient's hypoxia
  • disordersheart beat
  • bronchospasm
  • Subglottic laryngeal edema
  • laryngitis
  • tracheitis

Exstubation

Exstubationis the process of removing the tracheal tube from the trachea. Before deciding to extubate, make sure that the patient is able to breathe independently, has a preserved cough reflex, is conscious and responds to commands. Before removing the endotracheal tube, give the patient 100% oxygen for breathing and monitor blood saturation.

The extubation procedure consists in removing the air from the endotracheal tube sealing cuff with a syringe and removing it with a smooth, smooth movement of the hand. Possible complications of the procedure include sore throat, laryngeal edema, paralysis of the vocal cords, ulceration and narrowing of the trachea.

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