Background

Tracheal intubation is a medical procedure in which a flexible tube is inserted into the trachea.

Tracheal tubes vary in size and design for different patients with cuffs help aspiration prevention and ensure good ventilation.

Direct laryngoscopy is used as a traditional method in which a laryngoscope sees vocal cords for intubation.

Procedure conducted using direct or video laryngoscopy guidance and selection of technique are based on clinical scenario and anatomy of patient.

Indications

Tracheal intubation indicated for upper airway blockage including angioedema and epiglottitis.

Intubation used in respiratory failure cases, including acute respiratory distress syndrome (ARDS) treatment for patient.

Patients with less consciousness level may need this procedure to protect airway.

Tracheal intubation indicated during cardiopulmonary resuscitation to give open airway.

Contraindications

Tracheal intubation is not performed in cardiac arrest with no chance of recovery.

It should be contraindicated in patients with skull fractures because it causes cerebrospinal fluid leakage.

In severe hypoxemia or hemodynamic instability cases, the risks associated with intubation may beat the potential benefits.

Patients with intact protective airway reflexes may not need intubation unless necessary.

Outcomes

It controls oxygen supply and ventilation, which improves oxygen level in patients.

Intubation prevents aspiration, thus decreases risk of pneumonia, and minimizes complications.

Monitor intubated patients for respiratory parameters such as oxygen saturation and CO2.

Intubation indicates resolved condition or improved respiratory function, which is required in ongoing support for smooth recovery.

Equipment

• Laryngoscope
• Endotracheal Tubes
• Stylet
• Suction Apparatus
• End-tidal Carbon Dioxide Monitoring
• Oropharyngeal and Nasopharyngeal Airway Devices

Patient Preparation

Informed Consent:

The procedure should be thoroughly discussed with the patient, to ensure informed consent.

 Patient Positioning:

Place patient in optimal airway alignment, usually with head in sniffing position for vocal cord visualization.

Technique

Step 1: Anesthesia

Inject sedatives as anesthesia for relaxing muscles. Before this ensure proper supply of oxygen for patient during intubation.

Step 2: Vocal Cord Visualization

The surgeon inserted laryngoscope in mouth, then slowly displaced to see the epiglottis.

Lift epiglottis to expose vocal cords for visualization.

Step 3: Tube insertion

Insert endotracheal tube through mouth along tongue curve then guide towards glottis.

Use correct air volume of cuff endotracheal tube to prevent aspiration.

                             Fig. Anterior neck view

Step 4: Confirmation

Confirm proper endotracheal tube placement with help of chest X-ray and listening stable breath sounds.

Complications

Intubation has risks of introducing pathogens, which increase pneumonia in respiratory patients.

Misuse of laryngoscope blade and endotracheal tube insertion may damage larynx and trachea.

Misplacement of endotracheal tube can lead to insufficient breathing support.

Incorrect tube placement or cuff inflation can lead to gastric aspiration.

References

Endotracheal Tube Intubation Techniques – StatPearls – NCBI Bookshelf (nih.gov)

References

Endotracheal Tube Intubation Techniques – StatPearls – NCBI Bookshelf (nih.gov)