intubation
Meaning of intubation: Placing a tube where an awake body will not tolerate one, which is why it nearly always follows sedation or unconsciousness.
Definition of intubation
Intubation is the placing of a tube into the windpipe, passed through the mouth or nose and between the vocal cords, so that air, oxygen or anesthetic gas can be delivered straight to the lungs. A soft cuff near the tip is inflated to seal the airway. It is performed for general anesthesia and whenever breathing fails or the airway can no longer protect itself.
Why place a tube at all?
It does three jobs at once. It holds the passage open, which matters because the tongue and throat muscles of an unconscious person slacken and fall back across the airway. It gives a ventilator a sealed route into the lungs, since a machine cannot push air against leaks. And the inflated cuff blocks stomach contents from running down into the lungs, a chemical injury called aspiration that unconsciousness invites, because the cough and swallow reflexes that normally guard against it are switched off. General anesthesia creates all three problems deliberately, which is why the tube belongs to planned surgery as much as to emergencies.
How is it done?
A curved blade called a laryngoscope is slid over the tongue to lift it and the flap of tissue behind it clear of the line of sight, bringing the vocal cords into view either directly or through a camera at the blade tip. The tube passes between the cords, the cuff is inflated, and position is confirmed by detecting carbon dioxide in the air coming back out, since only air that has been inside the lungs carries it. Drugs that sedate and relax the muscles usually come first. When the reason is a failing airway rather than a planned operation, the situation is time-critical by its nature, because the person is moving little or no air while it is happening.
How does it compare with the alternatives?
| Method | Where it sits | Suited to |
|---|---|---|
| Bag and mask | Outside the body, over the face | Short periods, and while preparing for something else |
| Supraglottic airway | In the throat, above the vocal cords | Short procedures with little aspiration risk |
| Endotracheal tube | Through the cords into the windpipe | Ventilation and protection against aspiration |
| Surgical airway | Through an opening in the front of the neck | Long-term ventilation, or a blocked upper airway |
Recognized problems run from trivial to serious. Sore throat, hoarseness and chipped teeth are common and short-lived. A tube that slips too far enters the right main airway and ventilates one lung only. A tube passed into the food pipe by mistake delivers nothing, which is why the carbon dioxide check settles the question rather than appearance alone. Days of ventilation raise the risk of pneumonia acquired through the tube, and prolonged pressure inside the windpipe can leave scarring behind, which is among the reasons a tracheostomy is considered when ventilation runs into weeks.
Also known as
Used in a sentence
Intubation was performed for airway protection before transfer to intensive care.
Good to know
A tube placed in the food pipe rather than the windpipe delivers nothing, so placement is confirmed by detecting exhaled carbon dioxide rather than by appearance, and prolonged intubation is associated with pneumonia and later narrowing of the windpipe.
Word origin
Where “intubation” comes from
Formed from the Latin in-, meaning into, and tuba, a tube or trumpet.