Endotracheal intubation involves passing an endotracheal tube through the mouth or nose into the trachea. Intubation provides a patent airway when the patient is having respiratory distress that cannot be treated with simple methods. Endotracheal intubation is the method of choice in emergency care which is basically a means of providing an airway for individuals who cannot maintain an adequate and effective airway on their own (comatose patients, patients with upper airway obstruction), for patients requiring the assistance of mechanical ventilation in order to survive.
An endotracheal tube normally is passed with the assistance of a Laryngoscope by specifically trained medical, nursing or respiratory therapy personnel. Once the tube is inserted, a cuff is inflated to prevent air from leaking around the outer part of the tube and to further minimize the possibility of subsequent respiration as well as to prevent movement of the tube.
Complications of Endotracheal Intubation
The health care provider should be aware of the possible complications that could occur from pressure exerted by the cuff on the tracheal wall. Cuff pressures should be regularly checked with the use of a calibrated aneroid manometer every 6-8 hours in order to maintain a cuff pressure between 15mmHg to 20 mmHg. High cuff pressures can result in tracheal bleeding, ischemia and necrosis while a low cuff pressure increases the risk for aspiration pneumonia. Routine deflation of the cuff is not recommended due to the increased risk for aspiration and hypoxia. The cuff is normally deflated before the endotracheal tube is removed.
Care of patients with endotracheal intubation
When caring for patients with endotracheal intubation, warm humidified oxygen should always be introduced through the tube, whether the patient is breathing spontaneously or is receiving ventilator support. It is important to consider that endotracheal intubation may not be used for more than three successive weeks, by which time a tracheostomy must be considered to decrease irritation of and trauma to the tracheal lining and in order to reduce the incidence or vocal cord paralysis and to decrease the workload of inspiratory and expiratory breathing. It is imperative to consider that both endotracheal tubes and tracheostomy tubes has several disadvantages.
Discomforts and risks of endotracheal intubation
Both of the tubes can cause varying degrees of discomfort. The cough reflex is depressed due to the closure of the glottis is hindered. Moreover, secretions tend to become much thicker due to the warming and humidifying effect of the upper respiratory tract that has been bypassed. The swallowing reflex,
composed of the glottic, pharyngeal and laryngeal reflexes are depressed because of prolonged disuse and mechanical trauma produced by the endotracheal and tracheostomy tube, significantly increasing the risk of aspiration. In addition, ulceration and stricture of the larynx or trachea may gradually develop. However, the greatest concern for the patient is the inability to speak and to communicate needs. Finally, the most meticulous untoward reaction patients with endotracheal tubes inserted in their respiratory tract is the unintentional or premature removal of the tube which is considered a life threatening complication of endotracheal intubation. The best way to prevent such accidental or even intentional removal of the endotracheal intubation is providing frequent comfort measures that would improve the overall tolerance of the patient under endotracheal intubation.