Intubation Explained

Intubation is a procedure that's used when you can't breathe on your own. Your doctor puts a tube down your throat and into your windpipe to make it easier to get air into and out of your lungs. A machine called a ventilator pumps in air with extra oxygen. Then it helps you breathe out air that’s full of carbon dioxide (CO2). This is called mechanical ventilation. It helps keep your oxygen and CO2 at healthy levels.

Why You Might Need It

The drugs that put you to “sleep” during surgery (general anesthesia) may also hold down your breathing. Intubation lets a machine breathe for you. That’s why your anesthesiologist (the doctor who puts you to sleep for surgery) might intubate you.

Your doctor also may do it if you have an injury or illness that makes it hard to breathe. That’s because breathing provides oxygen that every cell in your body needs. If you don’t get enough, you can pass out, have brain damage, and even die. Ventilation also helps you breathe out. This helps get rid of CO2 so that it doesn't build up in your blood and make it more acidic (respiratory acidosis). That can lead to other health problems.

Sometimes, even if you appear to be breathing normally and your blood oxygen levels look fine, you may need intubation. Your doctor might want to do it because you’re unconscious. You may have an illness or injury that’s quickly getting worse, or that weakens reflexes in your airway.

A doctor may intubate you if you need emergency surgery that calls for general anesthesia. In this case, it's likely that you haven’t fasted to empty your stomach as you would for a planned procedure. Food from your stomach could get into your lungs (aspiration) if you vomit, or if it flows backward from your stomach. To keep this from happening, the tube has an air bladder that balloons up to seal off your airway from your stomach.

What to Expect

Except in rare cases, your doctor will give you drugs to partly or completely knock you out before they put the tube in. They also typically give you a drug to paralyze your airway. This is so your body doesn’t fight against the insertion by gagging or other reflexes.

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You might get plain oxygen from a mask for 2 or 3 minutes before the procedure starts to raise the level in your blood. You’ll lie faceup, and your doctor will tilt your head slightly back. They'll insert a scope with a light on it into your mouth. This lights up the airway. They'll look through the scope, or at a video screen if there is a camera attached.

The doctor will then thread the tube between your vocal cords and down into your windpipe. That's the part of your airway that connects to your lungs. Once the tube is at the right spot, your doctor blows up the cuff on the tube. This seals off much of your airway from your stomach and keeps food from getting into your lungs. But air can still flow through the tube.

Unless there are problems, the process shouldn’t take more than 5 minutes. Your doctor may still need to check how the tube's placed. They'll listen to your breathing with a stethoscope, check your CO2 levels, or take a chest X-ray.

Complications

It's rare for intubation to cause problems, but it can happen. The scope can damage your teeth or cut the inside of your mouth. The tube may hurt your throat and voice box, so you could have a sore throat or find it hard to talk and breathe for a time. The procedure may hurt your lungs or cause one of them to collapse. You might also get an infection or pneumonia.

Certain things can make these problems more likely. If you've just eaten, there's a risk that the food can be pulled into your lungs. There's a greater chance that the scope will damage your teeth if they're in poor shape. If you smoke, have a lung disease such as COPD, have a neck or spine injury, or you're overweight, it can make intubation and recovery harder.

WebMD Medical Reference Reviewed by Paul Boyce, MD on July 21, 2019

Sources

SOURCES:

American Thoracic Society: “Endotracheal Intubation by Direct Laryngoscopy.”

Medscape: “Rapid Sequence Intubation.”

Merck Manual: "Respiratory Failure," “Drugs To Aid Intubation,” “Tracheal Intubation.”

Patel, S., Majmundar, S. Physiology, Carbon Dioxide Retention, Statpearls, 2019.

UpToDate: “Rapid sequence intubation for adults outside the operating room,” “The decision to intubate,” “Direct laryngoscopy and endotracheal intubation in adults.”

Winchester Hospital Health Library: “Intubation and Mechanical Ventilation.”

Henry Frysh, MD, Atlanta. 

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