Tracheal Intubation

Tracheal Intubation

Tracheal intubation, commonly known as intubation, involves inserting a flexible plastic or rubber tube into the trachea (windpipe) to keep the airway open or to administer specific drugs. It is often performed in critically injured, ill, or anesthetized patients to assist with lung ventilation and to prevent asphyxiation or airway blockage. The primary method is orotracheal intubation, where an endotracheal tube is passed through the mouth and vocal cords into the trachea.

Nasotracheal intubation is another method, where the tube is passed through the nose and vocal cords into the trachea. Surgical methods, such as cricothyrotomy and tracheotomy, are used in emergencies or situations requiring prolonged airway support when conventional intubation is not feasible.

Due to its invasive and uncomfortable nature, intubation is typically performed after administering general anesthesia and a neuromuscular-blocking drug. However, it can also be done in awake patients with local or topical anesthesia or in emergencies without any anesthesia. Intubation is usually guided by a laryngoscope, flexible fiberoptic bronchoscope, or video laryngoscope to visualize the glottis.

Once the trachea is intubated, a balloon cuff is inflated above the tube's end to secure it, prevent gas leakage, and protect the airways. The tube is then connected to a breathing circuit or mechanical ventilator. When ventilation support is no longer needed, the tube is removed, known as extubation.

In the past, tracheotomy was the preferred method for intubating the trachea, but advances in anatomy, physiology, and endoscopic instrumentation led to the adoption of non-surgical intubation methods. Tracheal intubation has become a vital procedure in various medical specialties, including anesthesiology, critical care medicine, emergency medicine, gastroenterology, laryngology, pulmonology, and surgery.

Although tracheal intubation is generally safe, it can lead to minor complications such as dental damage or upper airway tissue injuries, as well as serious complications like pulmonary aspiration or unrecognized esophageal intubation, which can be fatal.

Therefore, careful evaluation of potential difficulties or complications, along with alternative airway management strategies, is essential. Tracheal intubation is necessary in situations where illness or medical procedures hinder a person's ability to maintain a clear airway, breathe, and oxygenate the blood, as simple oxygen supplementation through a face mask is insufficient.