Table of ContentsView AllTable of ContentsUsesTypesPreparationProcedureRemovalSide EffectsProlonged Intubation
Table of ContentsView All
View All
Table of Contents
Uses
Types
Preparation
Procedure
Removal
Side Effects
Prolonged Intubation
Anendotracheal tubeis a flexible tube that is placed in thetrachea(windpipe) through the mouth or nose. It can be used to assist with breathing during surgery or to support breathing in people withlung disease, chest trauma, or airway obstruction.
Medications and numbing sprays can help reduce discomfort and make the placement of the tube easier. However, endotracheal tubes can cause side effects like vocal hoarseness and sore throat. When used for a prolonged time, severe complications like pneumonia and collapsed lung may occur.
This article explains when endotracheal tubes are needed, how they are placed, and the possible risks and complications.
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What Is Endotracheal Intubation?
Why Are Endotracheal Tubes Used?
An endotracheal tube is often used during surgery and in emergency situations. It is typically placed when a person is unable to breathe on their own. The placement of the tube is called endotracheal intubation.
There are many reasons why endotracheal intubation is used, including:
When a Ventilator is Needed After Surgery
Endotracheal Tube Types and Sizes
Endotracheal tubes are flexible tubes made from different materials, such as polyvinyl chloride (PVC), rubber, or silicone.
An endotracheal tube may have one or two channels, known aslumens. A double-lumen endotracheal tube is often used when it is necessary to ventilate each lung separately, such with certain lung or chest surgeries.
Endotracheal tubes come in different sizes ranging from 2.0 to 10.5 millimeters (mm) in diameter. The bigger tubes are used for larger adults and the smallest ones are used for premature babies.
At the end of most endotracheal tubes is an inflatable balloon called aballoon cuff. The cuff is inflated to keep the tube securely in place in the mouth after intubation.
How to Prepare for an Endotracheal Tube
If you’re having a planned procedure where endotracheal intubation will be used, there are things you can do to prepare:
Why You Can’t Eat or Drink Before Surgery
How Endotracheal Intubation Is Done
An endotracheal tube is usually placed when a person is unconscious. If it is done while a person is conscious, medications can be used to help ease anxiety and prevent nausea.
Before Intubation
Before an endotracheal tube is placed:
Intubation
During endotracheal intubation, the practitioner usually stands at the head of the table looking toward the person’s feet. Pillows or padding may be placed under the person’s head or neck to make airway access easier.
To perform endotracheal intubation:
After the tube is connected to the mechanical ventilator, respiratory vital signs are continuously monitored. Secretions may be suctioned occasionally to keep the tube clear.
Endotracheal Tube Removal
Before removing the tube (extubation) and disconnecting it from the ventilator, the healthcare provider will assess whether the person is able to breathe on their own.
If indications are good, the tape holding the tube on the face is removed. The balloon cuff is then deflated, and the tube is firmly and steadily pulled out. The removal may feel odd, but it is usually not painful.
Why You May Be Asked to Cough After Surgery
Side Effects and Risks of Endotracheal Tubes
A sore throat is common following endotracheal intubation. It usually lasts a few days.
Around one-third to half of people who have been intubated experience vocal hoarseness for up to a week. Less than 1% have hoarseness for longer than a week.
Possible Complications
Complications of endotracheal intubation tend to affect people who had emergency intubation, have a pre-existing lung condition, or have been intubated for more than seven days.
These include:
If endotracheal intubation is scheduled, it is usually removed soon after the procedure is completed. Other people may need intubation and mechanical ventilation longer due to a severe or critical illness.
Even so, the tube cannot be left indefinitely and should be removed within 14 days. Leaving it in any longer can cause the thinning of cartilage and the narrowing of the airway passage.
Others with serious medical conditions may need a feeding tube placed through a hole in their abdomen. These include apercutaneous endoscopic gastrostomy (PEG) tube, which delivers food to the stomach, and ajejunostomy tube (J-tube), which delivers food to the small intestine.
Summary
There are many uses for endotracheal intubation. Endotracheal tubes support breathing during surgery or for those unable to breathe on their own for any number of reasons. It can also be used to remove foreign objects from the airways or to protect the airways if there is severe gastrointestinal bleeding.
Common side effects like hoarseness or sore throat typically clear within a few days. The risk of serious complications like pneumonia increases if intubation is needed for more than seven days.
Risks of Mechanical Ventilation With COVID-19
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Haas CF, Eakin RM, Konkle MA, Blank R.Endotracheal tubes: old and new.Respiratory Care. 2014;59(6):933-955. doi:10.4187/respcare.02868Hao D, Saddawi-Konefka D, Low S, Alfille P, Baker K.Placement of a double-lumen endotracheal tube. Ingelfinger JR, ed.N Engl J Med. 2021;385(16):e52. doi:10.1056/NEJMvcm2026684Ahmed RA, Boyer TJ.Endotracheal tube. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan 2022.American Society of Anesthesiologists.Smoking.Hua F, Xie H, Worthington HV, Furness S, Zhang Q, Li C.Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Oral Health Group, ed.Cochrane Database of Systematic Reviews. October 25, 2016. doi:10.1002/14651858.CD008367.pub3Nimmagadda U, Salem MR, Crystal GJ.Preoxygenation: physiologic basis, benefits, and potential risks.Anesth Analg. 2017;124(2):507-517. doi:10.1213/ane.0000000000001589Meier S, Geiduschek J, Paganoni R, Fuehrmeyer F, Reber A.The effect of chin lift, jaw thrust, and continuous positive airway pressure on the size of the glottic opening and on stridor score in anesthetized, spontaneously breathing children.Anesth Analg. 2002;94(3):494-9. doi:10.1097/00000539-200203000-00004Lewis SR, Butler AR, Parker J, Cook TM, Smith AF.Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation.Cochrane Database Syst Rev. 2016;11(11):CD011136. doi:10.1002/14651858.CD011136.pub2Touman AA, Stratakos GK.Long-term complications of tracheal intubation.Tracheal Intubation. 2018. doi:10.5772/intechopen.74160Yale Medicine.Ventilators and COVID-19: What You Need to Know, June 2, 2020.Additional ReadingNational Library of Medicine. MedlinePlus.Endotracheal intubation.Ono Y, Kakamu T, Kikuchi H, Mori Y, Watanabe Y, Shinohara K.Expert-performed endotracheal intubation-related complications in trauma patients: Incidence, possible risk factors, and outcomes in the prehospital setting and emergency department.Emerg Med Int. 2018 Jun 10;2018:5649476. doi:10.1155/2018/5649476
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Haas CF, Eakin RM, Konkle MA, Blank R.Endotracheal tubes: old and new.Respiratory Care. 2014;59(6):933-955. doi:10.4187/respcare.02868Hao D, Saddawi-Konefka D, Low S, Alfille P, Baker K.Placement of a double-lumen endotracheal tube. Ingelfinger JR, ed.N Engl J Med. 2021;385(16):e52. doi:10.1056/NEJMvcm2026684Ahmed RA, Boyer TJ.Endotracheal tube. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan 2022.American Society of Anesthesiologists.Smoking.Hua F, Xie H, Worthington HV, Furness S, Zhang Q, Li C.Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Oral Health Group, ed.Cochrane Database of Systematic Reviews. October 25, 2016. doi:10.1002/14651858.CD008367.pub3Nimmagadda U, Salem MR, Crystal GJ.Preoxygenation: physiologic basis, benefits, and potential risks.Anesth Analg. 2017;124(2):507-517. doi:10.1213/ane.0000000000001589Meier S, Geiduschek J, Paganoni R, Fuehrmeyer F, Reber A.The effect of chin lift, jaw thrust, and continuous positive airway pressure on the size of the glottic opening and on stridor score in anesthetized, spontaneously breathing children.Anesth Analg. 2002;94(3):494-9. doi:10.1097/00000539-200203000-00004Lewis SR, Butler AR, Parker J, Cook TM, Smith AF.Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation.Cochrane Database Syst Rev. 2016;11(11):CD011136. doi:10.1002/14651858.CD011136.pub2Touman AA, Stratakos GK.Long-term complications of tracheal intubation.Tracheal Intubation. 2018. doi:10.5772/intechopen.74160Yale Medicine.Ventilators and COVID-19: What You Need to Know, June 2, 2020.Additional ReadingNational Library of Medicine. MedlinePlus.Endotracheal intubation.Ono Y, Kakamu T, Kikuchi H, Mori Y, Watanabe Y, Shinohara K.Expert-performed endotracheal intubation-related complications in trauma patients: Incidence, possible risk factors, and outcomes in the prehospital setting and emergency department.Emerg Med Int. 2018 Jun 10;2018:5649476. doi:10.1155/2018/5649476
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Haas CF, Eakin RM, Konkle MA, Blank R.Endotracheal tubes: old and new.Respiratory Care. 2014;59(6):933-955. doi:10.4187/respcare.02868Hao D, Saddawi-Konefka D, Low S, Alfille P, Baker K.Placement of a double-lumen endotracheal tube. Ingelfinger JR, ed.N Engl J Med. 2021;385(16):e52. doi:10.1056/NEJMvcm2026684Ahmed RA, Boyer TJ.Endotracheal tube. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan 2022.American Society of Anesthesiologists.Smoking.Hua F, Xie H, Worthington HV, Furness S, Zhang Q, Li C.Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Oral Health Group, ed.Cochrane Database of Systematic Reviews. October 25, 2016. doi:10.1002/14651858.CD008367.pub3Nimmagadda U, Salem MR, Crystal GJ.Preoxygenation: physiologic basis, benefits, and potential risks.Anesth Analg. 2017;124(2):507-517. doi:10.1213/ane.0000000000001589Meier S, Geiduschek J, Paganoni R, Fuehrmeyer F, Reber A.The effect of chin lift, jaw thrust, and continuous positive airway pressure on the size of the glottic opening and on stridor score in anesthetized, spontaneously breathing children.Anesth Analg. 2002;94(3):494-9. doi:10.1097/00000539-200203000-00004Lewis SR, Butler AR, Parker J, Cook TM, Smith AF.Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation.Cochrane Database Syst Rev. 2016;11(11):CD011136. doi:10.1002/14651858.CD011136.pub2Touman AA, Stratakos GK.Long-term complications of tracheal intubation.Tracheal Intubation. 2018. doi:10.5772/intechopen.74160Yale Medicine.Ventilators and COVID-19: What You Need to Know, June 2, 2020.
Haas CF, Eakin RM, Konkle MA, Blank R.Endotracheal tubes: old and new.Respiratory Care. 2014;59(6):933-955. doi:10.4187/respcare.02868
Hao D, Saddawi-Konefka D, Low S, Alfille P, Baker K.Placement of a double-lumen endotracheal tube. Ingelfinger JR, ed.N Engl J Med. 2021;385(16):e52. doi:10.1056/NEJMvcm2026684
Ahmed RA, Boyer TJ.Endotracheal tube. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; Jan 2022.
American Society of Anesthesiologists.Smoking.
Hua F, Xie H, Worthington HV, Furness S, Zhang Q, Li C.Oral hygiene care for critically ill patients to prevent ventilator-associated pneumonia. Cochrane Oral Health Group, ed.Cochrane Database of Systematic Reviews. October 25, 2016. doi:10.1002/14651858.CD008367.pub3
Nimmagadda U, Salem MR, Crystal GJ.Preoxygenation: physiologic basis, benefits, and potential risks.Anesth Analg. 2017;124(2):507-517. doi:10.1213/ane.0000000000001589
Meier S, Geiduschek J, Paganoni R, Fuehrmeyer F, Reber A.The effect of chin lift, jaw thrust, and continuous positive airway pressure on the size of the glottic opening and on stridor score in anesthetized, spontaneously breathing children.Anesth Analg. 2002;94(3):494-9. doi:10.1097/00000539-200203000-00004
Lewis SR, Butler AR, Parker J, Cook TM, Smith AF.Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation.Cochrane Database Syst Rev. 2016;11(11):CD011136. doi:10.1002/14651858.CD011136.pub2
Touman AA, Stratakos GK.Long-term complications of tracheal intubation.Tracheal Intubation. 2018. doi:10.5772/intechopen.74160
Yale Medicine.Ventilators and COVID-19: What You Need to Know, June 2, 2020.
National Library of Medicine. MedlinePlus.Endotracheal intubation.Ono Y, Kakamu T, Kikuchi H, Mori Y, Watanabe Y, Shinohara K.Expert-performed endotracheal intubation-related complications in trauma patients: Incidence, possible risk factors, and outcomes in the prehospital setting and emergency department.Emerg Med Int. 2018 Jun 10;2018:5649476. doi:10.1155/2018/5649476
National Library of Medicine. MedlinePlus.Endotracheal intubation.
Ono Y, Kakamu T, Kikuchi H, Mori Y, Watanabe Y, Shinohara K.Expert-performed endotracheal intubation-related complications in trauma patients: Incidence, possible risk factors, and outcomes in the prehospital setting and emergency department.Emerg Med Int. 2018 Jun 10;2018:5649476. doi:10.1155/2018/5649476
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