Intubation

Overview of Treatment

Tracheal intubation is a critical procedure commonly performed in emergency and surgical settings, primarily used to ensure airway patency and facilitate effective gas exchange. This treatment involves inserting a flexible tube (endotracheal tube) into the trachea, directly connecting to a ventilator or manual resuscitation device, applicable in cases of respiratory failure, general anesthesia, or coma. Its core purpose is to maintain an open airway, prevent suffocation, and ensure adequate oxygen delivery to the lungs. In emergency rooms, operating theaters, and intensive care units, tracheal intubation is a life-saving measure but must be performed by trained healthcare professionals.

Types and Mechanisms

Tracheal intubation can be performed via oral or nasal routes. Oral intubation is more common in emergency situations due to shorter procedure time and larger tube diameter, suitable for short-term emergency care; nasal intubation is used for long-term ventilation or when reducing laryngeal stimulation is desired. The mechanism involves: 1. Preventing the tongue base from falling back or secretions from obstructing the airway; 2. Controlling ventilation volume and oxygen concentration through a ventilator; 3. Direct removal of lower airway secretions. The tube material is usually PVC or silicone, with diameter adjusted based on patient age—typically 7-9mm for adults.

Indications

Main indications include:

Patients with respiratory failure requiring mechanical ventilation support
Ensuring airway security during general anesthesia
Severe cranial trauma or drug overdose leading to loss of consciousness
Severe airway obstruction (e.g., severe stridor or pulmonary edema)

Special cases such as airway burns caused by fire or intrauterine distress requiring immediate post-birth ventilation also necessitate this treatment. It is important to note that tracheal intubation is not a permanent solution and is typically used for short to medium-term ventilation needs.

Method and Dosage

The procedure involves: 1. Anesthesia and sedation; 2. Clearing upper airway obstructions beforehand; 3. Visualizing the glottis with a laryngoscope; 4. Inserting the endotracheal tube below the vocal cords. Confirmation of tube placement should be done via auscultation, end-tidal CO₂ monitoring, and X-ray positioning. Ventilation parameters such as tidal volume (usually 6-8ml/kg) and respiratory rate (10-12 breaths/min) should be adjusted based on patient weight and blood gas analysis. The duration of intubation varies depending on the condition, but it is recommended to evaluate the need for extension every 24-48 hours.

Benefits and Advantages

Main advantages include:

Rapid restoration of blood oxygen saturation, reducing the risk of hypoxic brain injury
Direct oxygen delivery and CO₂ removal, suitable for complex ventilation requirements
Precise control of ventilation parameters when combined with a ventilator

Compared to mask oxygen therapy, advantages include avoiding secretion retention and managing critical situations with no spontaneous breathing. During surgery, it also ensures airway safety under anesthesia.

Risks and Side Effects

Potential risks include:

Mucosal injury: vocal cord trauma or laryngeal edema
Tracheal injury: such as tube displacement causing pneumothorax or subcutaneous emphysema
Infection risk: prolonged intubation may lead to ventilator-associated pneumonia (VAP)

Side effects may include dry mouth, temporary vocal cord dysfunction, and serious complications such as tracheal stenosis requiring immediate tube removal and ENT referral.

Precautions and Contraindications

Contraindications include:

Significantly increased intracranial pressure: may induce intracranial hypertension due to coughing
Severe cervical instability: manipulation may cause spinal cord injury
Tracheal anatomical abnormalities (e.g., tracheal stenosis)

Strict contraindications apply in cases of esophageal foreign bodies or significant upper airway bleeding. Prior to procedure, assess patient’s jaw clenching, neck mobility, and other physiological limitations.

Interactions with Other Treatments

Interactions with anesthetic drugs require special attention:

Deep sedatives may prolong recovery of spontaneous breathing
Combined use with bronchodilators can enhance ventilation efficiency
When used with antibiotics, increased tube care is necessary to reduce infection risk

Compare risks and benefits with alternatives such as high-flow oxygen therapy and tracheostomy, and select the most appropriate treatment based on the patient’s physiological condition.

Effectiveness and Evidence

Clinical evidence shows that properly performed tracheal intubation can reduce emergency airway obstruction mortality by over 40%. In patients with respiratory failure, blood gas analysis within 24 hours post-intubation shows an average increase of 50mmHg in PaO₂. Large retrospective studies indicate that when performed by trained teams, first-attempt success rates can reach 90%, reducing airway injury risk. However, long-term intubation beyond 7 days may increase ventilator-associated pneumonia incidence to 25-30%.

Alternatives

Alternatives include:

Nasal high-flow oxygen therapy: suitable for patients with mild ventilation impairment
Laryngeal mask airway (LMA): avoids direct tracheal stimulation but has lower ventilation efficacy
Tracheostomy: suitable for patients expected to require ventilation for more than 2 weeks

When choosing, consider urgency, patient anatomy, and resource availability—for example, in craniofacial trauma, LMA may be a safer alternative.

Frequently Asked Questions

What preparations are needed before intubation?

Before intubation, healthcare providers will administer general or local anesthesia and explain the procedure and risks in detail. Patients should fast for 6-8 hours beforehand and remove dentures or foreign objects from the mouth and nose. If the patient has airway abnormalities such as deviation or stenosis, imaging studies may be required to assess difficulty, ensuring smooth procedure execution.

How can the risk of vocal cord damage after intubation be prevented?

Intubation may cause vocal cord swelling or injury. Healthcare providers will select appropriately sized endotracheal tubes to minimize contact area. Patients should avoid speaking loudly or coughing within 24 hours after waking up, and can communicate via writing. Voice protection training, such as gentle vocal exercises daily, can reduce the risk of long-term vocal cord dysfunction.

How to maintain oral hygiene during intubation?

During intubation, oral mucosa should be checked every 2 hours by nursing staff, and saline rinses used to clean gums and tongue. Conscious patients can use alcohol-free mouthwash, spitting out after rinsing. After tube removal, gentle brushing with a soft toothbrush is recommended to avoid irritating the still-healing mucosa.

What are the differences between pediatric and adult intubation?

Pediatric intubation requires adjusting tube size based on weight and securing it properly to prevent displacement. The pediatric airway is narrower than adults, and procedures are typically limited to 72 hours to reduce airway injury risk. Adult patients should consider underlying chronic conditions (e.g., diabetes) affecting recovery and strengthen respiratory muscle training.

What is the success rate and typical recovery period for intubation?

In ICU patients, if the primary disease is well-controlled, intubation usually lasts 7-14 days before gradually weaning off the ventilator. After successful extubation, observation continues for 48-72 hours, often with respiratory therapy and rehabilitation. Overall recovery time varies; severe respiratory failure patients may need weeks to months to regain lung function.