Endotracheal Intubation I: Procedure

An endotracheal tube includes a standard adaptor for connecting a bag-valve-mask or ventilator, a cuff that seals the airway, a pilot balloon for monitoring cuff pressure, and radiopaque markings to measure insertion depth. These components work together to secure the airway and enable proper ventilation and gas exchange.

Orotracheal intubation is preferred in emergencies because it allows rapid airway securing and accommodates larger diameter tubes, which reduces breathing resistance and facilitates easier suction and removal of secretions. Although nasotracheal insertion is better tolerated by patients, it requires narrower tubes and is more complex to perform.

Endotracheal tube sizes typically range from 7.0 to 8.0 millimeters in internal diameter. Females generally require a 7.0 mm tube, while males typically need an 8.0 mm tube. Larger diameter tubes reduce breathing resistance and facilitate easier suction and removal of secretions.

Endotracheal intubation is indicated for acute respiratory distress, apnea, upper airway obstruction, ineffective clearance of secretions, high risk for aspiration, and during general anesthesia. It establishes and maintains a patent airway for patients who cannot maintain an adequate airway independently, including comatose patients and those with extensive upper airway edema.

The endotracheal tube connects to a ventilator through its standard adaptor, enabling control of respirations and ventilation of the lungs. The tube can remain in place for up to two weeks and may be used with mechanical ventilation ii invasive ventilation systems or airway pressure release ventilation to promote spontaneous breathing and improve gas exchange.

Nursing care includes monitoring vital signs and blood gas levels, changing the patient's position every two hours to prevent atelectasis, and providing humidification to keep inspired air moist. Nurses must observe for laryngeal edema and respiratory distress, provide oral care to prevent crusts and mucus buildup, and ensure emergency respiratory support equipment remains available.

The endotracheal tube is inserted through the mouth or nose, passed through the vocal cords, and advanced into the trachea with assistance from a laryngoscope or bronchoscope. Oral insertion is preferred because the airway can be secured rapidly, while nasal insertion requires a narrower tube but is better tolerated by conscious patients.