Intubation is the process of advancing a thin tube called an endotracheal tube from the mouth to the respiratory tract. Thanks to this method, the patient is connected to a device called a ventilator. Intubation is applied to patients to provide respiratory support in case of anesthesia, sedation or severe illness. Considering all these reasons, the intubation procedure is common today.
What is an Intubate?
Intubated patient mold has become a frequently encountered expression recently. For this reason, it has led many people to ask questions such as “What does an intubate mean, why are patients intubated?” Intubated patient means a patient who has undergone intubation.
Intubation is a procedure applied to patients who cannot maintain airway control or who cannot breathe without assistance. Patients undergoing intubation; There may be people who received general anesthesia before surgery or who could not meet the body’s oxygen need due to a severe illness.
Surgeries are usually done under general anesthesia. The anesthetic drugs administered to the patient neutralize the diaphragm muscle responsible for respiration, as well as other muscles in the body. Therefore, the patient does not have a chance to continue breathing under anesthesia. In most patients, the endetracheal tube inserted during intubation is removed after the operation is over and the anesthetic effect has disappeared. The patient continues to breathe on his own. However, if the patient has undergone a severe surgery such as open heart surgery or has a serious condition that prevents breathing, the tube is not removed immediately. The patient continues to breathe through the ventilator for a while.
Intubation is also needed when respiratory failure develops. In cases such as severe injury to the lungs, severe pneumonia, and COVID-19, intubation may be required to meet the patient’s oxygen need.
How is Intubation Performed?
Before the intubation procedure, the patient is under anesthesia or sedation or is not fully conscious due to severe illness. These reasons allow the patient’s mouth and respiratory tract to be opened more easily. Before intubation, the patient is placed flat on his back and the person who will perform the intubation passes to the side of the patient’s head. The person who will apply the procedure stands at his head so that he can see the patient’s face. Then the patient’s mouth is opened gently and with the help of a device with a light at the end, it is slowly advanced towards the throat. Pressure is applied to the tongue during the procedure so that the tongue does not obstruct the respiratory tract. The tube, which is advanced to the throat, continues to be advanced to the respiratory tract and is brought to the right place. When the intubation tube reaches the desired location, the small balloon-shaped structure inside the tube opens and thus the location of the tube is fixed. In order to check whether the intubation procedure is performed correctly, the patient’s lungs are listened to with a stethoscope. If breathing sounds are taken from the patient’s lungs, it means that the intubation was performed correctly.
Respiratory support of the patient is provided by nasal intubation during operations related to the mouth or throat. In nasal intubation, the tube called the nasotracheal tube is advanced from the nose to the upper respiratory tract. In this way, the patient continues to breathe with the tube advanced through the nose during oral operations. Under normal conditions, oral endotracheal intubation is preferred more frequently because it is an easier procedure. However, in some special cases, nasal intubation may be required.
Intubation in children, also known as pediatric intubation, is done in the same way as in adults. However, since children’s airways are narrower, smaller diameter instruments should be used during the procedure. For example, the endotracheal tube used in children has a smaller diameter. The size of this tube also varies among children, depending on the age and size of the child. The intubation process becomes more difficult due to the narrow airway in children. An experienced person should do the intubation very carefully. In some cases, help is taken from fiberobtic devices to facilitate intubation. The fiberoptic device is placed inside the intubation tube and the image obtained from this device is simultaneously monitored externally. Thus, it can be seen whether the tube is progressing correctly in the respiratory tract. When the tube reaches the desired area, the fiberoptic device inside is removed and respiratory support begins. Nasal intubation can also be used for intubation in newborns and infants.
After the patient’s intubation need is over, he passes the extubation process, that is, the tube extraction process. For this procedure, the tube must first be separated from the point where it is fixed outside the body. After this fixed area is released, the balloon part that fixes the tube to the respiratory tract is deflated. After the balloon is deflated, the intubation tube is gently pulled out of the body. The patient now begins to breathe on his own. After extubation, the patient is followed closely. If any respiratory distress is observed in the patient, if there is a decrease in oxygen saturation, different respiratory support applications may be considered.
Patients who show symptoms such as severe pain in the throat after extubation, difficulty in swallowing, chest pain, shortness of breath, and swelling of the face should definitely inform a healthcare professional of the situation.
What Are the Risks of Intubation?
As with any interventional procedure, intubating the patient also brings some risks. The longer the intubation time, the higher the likelihood of these risks or complications.
Risks associated with intubation:
- Trauma, injury to teeth, tongue, mouth and larynx
- Accidentally advancing the tube into the esophagus instead of the trachea (windpipe)
- Trachea injury
- Having problems weaning from the ventilator
- Aspirating saliva-like secretions (accidental entry of these substances into the respiratory tract)
- Aspiration-induced lung infection, pneumonia
- Throat ache
- Coarseness in voice
- It can be listed as damage to soft tissues in prolonged intubation.
- These risks are explained to the patient or patient’s relative before the intubation
- procedure. Even if healthcare professionals take all precautions to avoid these complications, intubation may still cause some harm to the patient. However, intubation is a procedure performed in mandatory situations, and this procedure must be done in order for the patient to continue breathing.
How Is Nutrition During Intubation?
If the intubation applied to the patient is for a short time, for example, if he is intubated for a few hours of operation and then the tube is planned to be removed immediately, the patient does not need nutrition. In this case, after the tube is removed from the patient, the patient can start normal nutrition at the time recommended by the doctor. However, in cases where intubation will take longer, the nutritional need of the patient should be met. In these cases, feeding is done through a vascular access (IV) or a tube placed in the stomach. For intravenous feeding, a mixture is prepared that contains the amount of carbohydrate, macromolecules such as protein and liquid required by the patient. This mixture is given to the patient gradually through an IV. Especially in cases where the patient will be intubated for a long time, the feeding method in which the tube is advanced to the patient’s stomach can be used. The patient can be fed by the nasogastric method, where a small tube is advanced from the patient’s mouth to the stomach, or a tube through the nose is advanced to the stomach. In these methods, the food to be consumed by the patient goes to the stomach through a thin tube. Since these feeding methods are more similar to normal nutrition, they can be used especially for long-term intubations.