Intubated
Intubated refers to a state where a patient has been provided with mechanical ventilation or oxygen support via an inserted airway tube. For an intubated patient, it means an intubation tube has been placed in their throat to support breathing through the airway. The intubation procedure is performed by inserting a tube into the trachea through the mouth or nose.
Intubating a patient is generally an emergency intervention and is necessary for the maintenance of vital functions. An intubation device is a life support unit that mechanically performs the patient's respiratory function.
What is Intubated?
To intubate is the process of inserting a breathing tube into a patient's airway. Being intubated is a life-saving intervention in situations such as loss of consciousness or respiratory failure. A patient with a tube inserted is called an intubated patient. Intubated patients receive respiratory support with an intubation tube inserted. Individuals intubated in intensive care usually experience life-threatening respiratory failure. This procedure may also be referred to by terms such as endotracheal intubation or tracheal intubation.
Being intubated means being placed on life support during treatment, so it is applied in cases of severe respiratory failure or similar conditions. In an intensive care setting, the risk of infection and complications for an intubated patient must be closely monitored. Intubated patient care is a sensitive process that requires special training and attention in terms of nursing. Intubated patient monitoring is ensured through ventilator settings control, body positioning, and secretion clearance.
In Which Situations Is Intubation Performed?
Intubation is generally applied to critical patients who cannot breathe sufficiently on their own. This procedure can be performed in the following emergency situations:
Trauma or Injury: Severe blows to the abdomen, chest, or neck area can obstruct the airway. In such a case, the airway is kept open via intubation.
Loss of Consciousness: Intubation may be required if a person cannot control their breathing due to deep loss of consciousness, fainting, or anesthesia.
Need for Surgical Procedure: Intubation is performed if the patient cannot breathe spontaneously during long surgical operations.
Respiratory Failure: In cases such as acute respiratory failure, intubation can be applied for oxygen support. Intubation may be inevitable for patients whose airways are completely closed or severely damaged. The airway patency and tube placement of patients intubated through the throat must be checked at regular intervals.
Aspiration Risk: If there is a danger of foreign substances such as swallowed food or vomit entering the lungs, the airways are protected via intubation.
Cardiac Arrest or Apnea: In cases of sudden cardiac arrest or temporary cessation of breathing, intubation is required to carry oxygen to the heart and keep the airway open.
Prematurity: An intubated baby usually receives respiratory support due to premature birth or congenital lung problems. Intubating a baby must be done carefully by neonatology specialists under sterile conditions. A baby being intubated is usually seen in cases of respiratory failure or severe lung development disorders. Intubated babies are closely monitored in an incubator and may receive surfactant therapy if necessary.
In these situations, intubation ensures that sufficient oxygen reaches the lungs by making the patient's airway secure.
How Is Intubation Performed?
The intubation procedure is generally performed by experienced healthcare personnel in an intensive care or operating room setting. The steps of the procedure are as follows:
Healthcare personnel first administer sedative and anesthetic drugs to the patient intravenously. This way, the patient being intubated is put to sleep and pain sensation is prevented. At the same time, an oxygen mask is applied to provide extra oxygen to the body.
The patient's head is tilted backward and the chin is lifted. This position facilitates the opening of the airway.
The physician, holding a device with a light and a hook (laryngoscope), advances through the mouth to reach the back of the throat. With the laryngoscope, the closing anatomy above the vocal cords (larynx) is opened.
The intubation tube (endotracheal tube) is usually passed through the vocal cords via the mouth and advanced toward the windpipe (trachea). Sometimes the tube can also be inserted through the nasal route (nasal route); this is a method preferred especially in head and neck surgeries.
The small balloon (cuff) at the tip of the tube is inflated with air to ensure the tube is fixed in the trachea. Thus, the tube does not come out and the delivered air escapes into the lungs.
Finally, a chest X-ray is taken or breath sounds are listened to in order to ensure the tube is in the correct position. If it is in the right place, the intubation procedure is complete.
The procedure is usually completed quickly. In emergency situations, an experienced team can perform intubation in less than a minute.
Is Intubation a Risky Procedure?
Intubation is a critical procedure applied to patients with severe respiratory distress, and in most cases, its benefits far outweigh its risks. Intubation is performed commonly and can be very effective in saving a patient's life. However, like every medical procedure, intubation also has some risks. Aspiration (the patient's vomit or blood entering the lungs), the tube accidentally going into one lung (one side of the bronchus), or the tube slipping into the esophagus instead of the windpipe are examples of these.
Additionally, damage may occur to tissues such as the mouth, teeth, tongue, or larynx during intubation; these can result in bleeding or swelling. During the intubation process, side effects related to anesthesia such as high fever or muscle cramps may also be seen. Although very rare, serious complications such as lung collapse due to increased pressure (tension pneumothorax) may develop.
How Long Does Intubation Last?
The duration of intubation is determined by the severity of the disease and when the patient can resume their own breathing. An experienced team can act very quickly in emergency conditions and complete intubation in a few seconds or under a minute. In a planned operating room, the procedure is usually finished within a few minutes along with preparations. What is important is that the procedure is performed without skipping necessary safety checks.
What Is the Process Like After Intubation?
After intubation is completed, the patient is connected to a mechanical ventilator (respirator) to provide respiratory support. The recovery process varies according to the patient's condition. Most patients begin to regain consciousness within a few hours; within a few days, they approach their pre-intubation respiratory capacity. After the procedure, mild throat pain, hoarseness, or difficulty swallowing may occur, but these usually resolve on their own within a week. If the intubation process has been very prolonged (e.g., for weeks), sometimes if permanent difficulty swallowing or speech difficulty occurs, brain-life specialists can be consulted. In general, after the patient is stabilized and begins to breathe comfortably after intubation, the tube is removed (via extubation) and the normal care process continues.
Frequently Asked Questions
An intubated patient recovers, but this process depends on the severity of the underlying disease and the response to treatment. The intubated recovery rate varies according to the patient's age, the type of disease, and the duration of the intervention. Intubation is a support method that facilitates the patient's breathing and assists in treatment. In one study, approximately 70% of patients intubated in the emergency department survived. Of course, this rate varies according to the patient's age, general health status, and the reason for intubation. Possible risks of intubation include aspiration (vomit/blood entering the lungs), the tube entering a single lung, or accidentally going into the esophagus. If these situations are not noticed, they can lead to serious consequences because oxygen support cannot be provided. Additionally, the risk of bacterial infection (e.g., sinusitis) increases during intubation. Injury to tissues such as the tongue, teeth, or vocal cords may develop. In very prolonged intubation, swelling around the throat, hoarseness, or difficulty swallowing may be seen. Apart from these, less common complications such as high fever during anesthesia, muscle cramps (malignant hyperthermia), or nerve damage may also occur. In summary, while intubation saves lives, one must be prepared for these risks. There are various types of intubation. Orotracheal intubation is the most common application performed through the mouth. In addition to this, a method called nasotracheal intubation can be applied by passing a tube through the nose; this is generally preferred in head, neck, or facial area surgeries. If the patient will remain intubated for a very long time or if oral intubation is not possible, it may be necessary to insert a tube directly into the trachea through a hole opened in the neck under the skin; this is called a tracheostomy. In short, there are two basic types of intubation (oral and nasal) plus surgical tracheostomy performed over a very long period. In the case of cardiac arrest, oxygen does not reach the body and the brain quickly becomes deprived of oxygen. It is very important to provide oxygen by protecting the airway during CPR. For this reason, intubation is also applied to patients whose hearts have stopped. According to experts, intubation in sudden cardiac arrest opens the windpipe to provide oxygen support and increases the effectiveness of drugs given intravenously. In other words, intubation increases the survival chances of patients whose hearts have stopped. There is no classification as 3rd-degree intubated in medical literature. There is no standard concept defined as degrees of intubation. Such expressions can mostly lead to misunderstanding. If this term appears in a source, it is likely referring to the severity of the patient's condition or another classification, it is not an official grading belonging to intubation. Prolonged intubation is generally used to describe a state of mechanical ventilation lasting longer than one week. Since prolonged intubation increases the risk of infection and tissue damage, in this case, a tracheostomy is often opened in the neck for the patient. That is, when a patient remains intubated for a long time, the surgical tracheostomy method is considered after a few days. During the prolonged intubation process, the patient's rehabilitation and the preservation of muscle functions are also of particular importance. Extubation is the process of removing the intubation tube. An intubated patient is extubated when they bring their respiratory functions to a sufficient level and become able to protect their airway themselves. According to guidelines, the treatment team evaluates the intubated patient every day to prepare for extubation and usually extubates patients who successfully pass the first spontaneous breathing trial. That is, if an intubated patient can breathe in and out on their own without high oxygen support, their care is ended in a planned manner and the tube is removed. When making the decision for extubation, factors such as the patient's state of consciousness, respiratory test results, oxygen need, and coughing are taken into consideration. The intubation procedure can be challenging for both the patient and the team. For this reason, intubated patients are usually kept under sedation (being put to sleep). Physicians put the patient to sleep by giving sedative and painkiller drugs intravenously before intubation is performed. Thus, the patient does not experience pain or panic during intubation and can breathe comfortably in harmony with the ventilator. As a result, the patient being intubated is put to sleep or placed under deep sedation during the procedure, which is necessary for both comfort and safety. Extubation, i.e., the termination of intubation, begins with the healthcare team deciding that the patient has become able to perform respiratory function on their own. First, the tape or strap securing the intubation tube in the throat is removed. Then, an aspiration device is used to clean the airway to remove phlegm and foreign substances in the respiratory tract. Later, the air inside the balloon at the tip of the tube is emptied. In the last step, the healthcare personnel asks the patient to take a deep breath and then cough or exhale; during this, the tube is slowly pulled back and removed. After the tube is pulled out, the patient may receive oxygen support with a catheter that keeps their mouth and throat moist for a while. After this procedure, observations lasting a few days are made; generally, sore throat or hoarseness after intubation may continue for a while but returns to normal over time. The long-term effects of intubation may differ slightly from short-term complications. In patients who remain intubated for a long time, the musculoskeletal system may weaken, and atrophic changes may be seen, especially in respiratory muscles. Trauma may also develop on the throat and vocal cords; for example, scarring, granuloma, or hoarseness may emerge. One study reported that prolonged intubation causes serious complications. Especially in those who have had a tube inserted for a long time, conditions such as polyps on the vocal cords, stenosis in the glottis, and vocal cord paralysis have been reported.
Intubation and Intensive Care Services at Hisar Hospital
Hisar Hospital Intercontinental provides 24/7 uninterrupted healthcare services for critical patients requiring intubation with its advanced intensive care infrastructure and experienced anesthesiology, intensive care, and emergency medicine specialists. Intubated patient monitoring, infection control, ventilator management, and extubation processes are carried out by multidisciplinary teams in accordance with international standards.
You can benefit from the safe and holistic treatment approach of Hisar Hospital's modern intensive care units in situations such as respiratory failure, severe infections, traumas, or the need for intensive care after surgery.
Contact us for detailed information about our intensive care and emergency health services.
