The term intubation generally refers to the insertion of a tube into a patient’s body, in an attempt to secure the airway and maintain normal tissue oxygenation. A very common procedure in hospital settings, intubation is linked to a number of possible complications. These include incorrect or failed placement of the tube, and voice box or larynx damage.
Intubation typically involves the placement of a tube in a person’s airway. The tube may be inserted through the mouth, a procedure known as endotracheal intubation. Alternatively, nasotracheal intubation may be used, via the patient’s nose. Endotracheal intubation is a very common procedure, typically used during surgery, as general anesthesia requires mechanical ventilation. The procedure may also be used as an emergent measure in cases of major trauma, severe allergic reactions, respiratory distress, spinal damage, and pulmonary embolism.
A potentially life-saving procedure, intubation is one of the ways physicians try to ensure that a patient’s breathing is not compromised. The process generally involves some form of conscious sedation and the administration of a paralytic agent. This ensures patient comfort and avoids complications that may arise due to the presence of a working gag reflex as the tube is inserted. This method has long been used in clinical practice. It has proven to be both safe and effective in the majority of cases.
The tube is first placed into the mouth. The tongue is moved out of the way with an instrument known as a laryngoscope. The tube is then inserted into the airway. Proper positioning of the patient is important. In cases where spinal trauma has been excluded, intubation may be performed with the patient’s neck in flexion and the head slightly extended. This allows for optimum visualization of the airway and can help minimize post-intubation complications.
Common endotracheal post-intubation complications include vocal cord or laryngeal damage, damage to the teeth, and incorrect tube placement. Incorrect intubation may involve insertion of the tube into the esophagus or in one of the lungs’ mainstem bronchi. Placement of the tube in the lung’s bronchus may lead to pneumothorax, a generally treatable condition. Intubation of the esophagus is a rare but serious post-intubation complication. It may lead to an esophageal perforation, or tear, or even death.
Most post-intubation complications, of both endotracheal and nasotracheal techniques, are treatable with early diagnosis. An x-ray taken shortly after tube placement may be a useful tool in avoiding many post-intubation complications. Proper assessment prior to intubation can help identify those with difficult airways and prevent failed procedures. Alternatives to intubation, such as a laryngeal mask airway, may be used in such cases. Use of a fiberoptic scope may also help prevent failed or incorrect tube placement, thereby reducing post-intubation complications.