Endotracheal Intubation Treatment Summary Sheet

Purpose of Endotracheal Intubation

What is the endotracheal intubation procedure? 

It is a measure to ensure ventilation and airway control by inserting a flexible plastic tube into the patient's airway.

The purpose of endotracheal intubation:

• Maintain respiration when the patient experiences respiratory failure.
• Support breathing when the patient has an airway obstruction.
• Protect the airway when the patient is in a coma or loses airway reflexes.
• Control the airway during surgeries requiring endotracheal general anesthesia.

Indications for Endotracheal Intubation 

Indications for the endotracheal intubation procedure include:

Clearing or protecting the airway

• Acute airway obstruction due to trauma, foreign bodies, upper respiratory tract burns, laryngeal edema or spasm, laryngeal tumors, etc.
• Loss of airway protective reflexes due to altered mental status caused by head trauma, cerebrovascular accidents, or central nervous system infections.
• Cardiac arrest.

Invasive mechanical ventilation

• Endotracheal general anesthesia during surgical procedures.
• Patients experiencing hypoxemic respiratory failure due to pulmonary edema, pneumonia, chest trauma, etc.
• Patients experiencing hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD), bronchial asthma.
• Decreased alveolar ventilation caused by neuromuscular disorders, central nervous system disorders, poisoning, etc.

Contraindications for Endotracheal Intubation

Contraindications for oral endotracheal intubation

Jaw ankylosis, jaw dislocation, nasopharyngeal tumors, maxillofacial trauma, jaw fractures, maxillopharyngeal surgeries.

Contraindications for nasal endotracheal intubation

Maxillofacial trauma, nasal-maxillofacial deformities, coagulation disorders, thrombocytopenia, sinusitis, turbinate hypertrophy, etc.

Endotracheal Intubation Procedure After checking the indications, contraindications, patient status, and the patient's/family's consent to perform the procedure, the physician will proceed with endotracheal intubation in the following sequence:

• The patient is attached to monitoring devices during the endotracheal intubation process.
• The patient is assisted with bag-valve ventilation and has their pharyngeal secretions thoroughly suctioned.
• The patient is administered anesthetic medications.
• The physician uses a laryngoscope to open the patient's mouth and locate the epiglottis. The physician then lifts the epiglottis to visualize the vocal cords.
• The physician inserts a flexible plastic tube between the two vocal cords and into the trachea.
• The physician squeezes the bag, carefully checks that air enters both of the patient's lungs, and secures the endotracheal tube. The patient will receive mechanical ventilation depending on their medical condition.

Possible Complications During Endotracheal Intubation

During endotracheal intubation

• Local trauma: injury to the lips, tongue, teeth, pharynx, or trachea, vocal cord damage, etc.
• Oropharyngeal and tracheal bleeding.
• Hypotension and bradycardia.
• Due to stimulation: Tachycardia, hypertension, cardiac arrhythmias.
• Tracheal tear.
• Pneumothorax.
• Cervical spine injury.
• Increased intracranial pressure.
• Esophageal intubation (misplacement).
• Vomiting and aspiration of gastric contents into the lower respiratory tract.

During the maintenance of the endotracheal tube and mechanical ventilation

• Lip and tongue ulcerations.
• Bronchospasm.
• Airway obstruction due to a kinked endotracheal tube or mucus plug.
• Endotracheal tube slipping too deep or pulling out.
• Aspiration into the lungs (rare).

After extubation

• Vocal cord injury.
• Hoarseness.
• Sinusitis, otitis media in cases of nasal endotracheal intubation.
• Necrosis of the oral, nasal, pharyngeal, and laryngotracheal mucosa.
• Tracheal stenosis.

"The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation."