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. It is indicated in cases of respiratory failure, general anesthesia, or coma. The main goal is to maintain an open airway, prevent suffocation, and ensure adequate oxygen delivery to the lungs. In emergency rooms, operating rooms, and intensive care units, tracheal intubation is a life-saving intervention 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. Directly clearing secretions from the lower respiratory tract. The tube material is usually PVC or silicone, with diameter adjusted based on patient age; adults typically use 7-9mm tubes.

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 from fire injuries or intrauterine distress requiring immediate ventilation after birth also necessitate this treatment. It is important to note that tracheal intubation is not a permanent solution and is generally used for short to medium-term ventilation needs.

Usage and Dosage

The procedure includes: 1. Anesthesia and sedation; 2. Pre-emptive removal of upper airway obstructions; 3. Visualization of the vocal cords using a laryngoscope; 4. Placement of the endotracheal tube below the vocal cords. Confirmation of tube placement should be done via auscultation, capnography, and X-ray positioning. Ventilation parameters such as tidal volume (usually 6-8ml/kg) and respiratory rate (10-12 breaths/min) should be adjusted according to patient weight and blood gas analysis. The duration of intubation depends on the clinical situation but should be evaluated every 24-48 hours for potential extension.

Benefits and Advantages

Main advantages include:

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

Compared to mask oxygen therapy, intubation avoids secretion retention and can handle critical situations with complete apnea. 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 spine instability: procedure 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 the procedure, evaluate physiological limitations such as jaw clenching and neck mobility.

Interactions with Other Treatments

Interactions with anesthetic drugs require special attention:

• Deep sedatives may prolong the return of spontaneous breathing
• Combination with bronchodilators can enhance ventilation efficiency
• When used with antibiotics, increased tube care is necessary to reduce infection risk

Compare the 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.

Treatment Outcomes 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 trained teams achieve a success rate of up to 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 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 over 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 prior and remove dentures or foreign objects from the mouth and nose. If the patient has tracheal deformities or stenosis, imaging studies may be necessary to assess difficulty, ensuring smooth procedure execution.

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

Intubation may cause vocal cord swelling or injury. Healthcare providers select appropriately sized endotracheal tubes to minimize contact. Patients should avoid speaking loudly or coughing within 24 hours after waking, and communication can be done 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 solution 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 mucosa that has not yet recovered.

What are the differences between pediatric and adult intubation?

Pediatric intubation requires adjusting tube size based on weight and securing it to prevent displacement. The pediatric airway is narrower than adults, and procedures are usually 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, the average duration of intubation is 7-14 days before weaning. After successful extubation, observation for 48-72 hours is necessary, possibly with respiratory therapy and rehabilitation. Overall recovery time varies; severe respiratory failure patients may need weeks to months to regain lung function.