ENDOTRACHEAL INTUBATION (ET)

Endotracheal intubation is the gold standard for establishing a definitive airway in critical care patients. It involves inserting a flexible plastic or rubber tube (the endotracheal tube or ETT) through the mouth or nose, past the vocal cords, and into the trachea (windpipe).

BENEFITS OF ET INTUBATION

• Secure airway: ET intubation provides a secure airway, preventing aspiration and allowing for controlled ventilation.
• Facilitates mechanical ventilation: ET tubes allow for the delivery of mechanical ventilation, which is essential for patients who cannot breathe adequately on their own.
• Delivers medications: Medications can be administered directly into the trachea through the ET tube.
• Permits airway suctioning: Secretions can be removed from the airway using suction catheters passed through the ET tube.

INDICATIONS FOR ET INTUBATION

• Respiratory failure: When the patient is unable to maintain adequate oxygenation or ventilation on their own.
• Airway obstruction: When the airway is obstructed by foreign objects, blood, vomit, or other causes.
• Protection of the airway: During surgery or procedures that involve the airway.
• To facilitate the administration of controlled ventilation during anesthesia.

RISKS AND COMPLICATIONS

• Esophageal intubation: The tube is accidentally inserted into the esophagus instead of the trachea. This can lead to aspiration and other complications.
• Vocal cord trauma: The laryngoscope blade can cause trauma to the vocal cords during insertion.
• Bleeding: Minor bleeding can occur at the insertion site.
• Infection: There is a risk of infection, especially if the tube is left in place for a prolonged period.

STEPS OF ENDOTRACHEAL INTUBATION

1. Preoxygenation: Administer high-flow oxygen for several minutes to build up oxygen reserves.
2. Positioning: Place the patient in the sniffing position (head slightly extended, neck flexed).
3. Laryngoscopy: Insert the laryngoscope blade into the mouth and visualize the vocal cords.
4. Passing the Endotracheal Tube: Advance the endotracheal tube through the vocal cords and into the trachea.
5. Confirmation of Placement: Confirm correct placement by auscultation (listening for breath sounds on both sides of the chest), capnography (detecting carbon dioxide in exhaled air), and chest X-ray (to confirm the tube’s position).

Endotracheal Intubation is a complex procedure that should only be performed by experienced healthcare professionals. It requires specialized training and practice to minimize the risk of complications.