Intubation and Mechanical Ventilation

Prior to Procedure

In the days leading up to your procedure:

• Do not start taking any new medication without consulting your doctor.
• The night before, eat a light meal; do not eat or drink anything after midnight.
• Consult with your doctor for any other special instructions.

Anesthesia

If you are going to be awake during the intubation procedure, a local anesthetic is used to numb your throat where the tube will pass. The anesthetic is in the form of a spray or a gargle. You may also receive a muscle relaxant to prevent you from gagging when the tube is inserted.

In addition, you may be given a sedative prior to the procedure since many patients have difficulty tolerating the procedure while fully awake. Further sedation may be necessary if the procedure is being performed prior to surgery or if there is a need for prolonged mechanical ventilation.

Description of the Procedure

You will wear an oxygen mask for 2-3 minutes before the procedure begins. This ensures that you have enough oxygen in your system during the procedure.

The doctor uses a tool called a laryngoscope to perform the intubation. The laryngoscope has a handle, a light, and a blade. It helps guide the endotracheal tube to its proper position.

The doctor tilts your head back slightly to make it easier to insert the laryngoscope. It is inserted through your mouth and down into your throat. Then the tip of the endotracheal tube is advanced down into the trachea.

Once the endotracheal tube is in position, the doctor removes the laryngoscope and the tube remains. The tube is taped to the corner of your mouth.

The endotracheal tube is then attached to a ventilator machine, which moves air in and out of your lungs.

In some cases, the tube is inserted through the nose instead of the mouth.

After Procedure

• A portable chest x-ray is taken immediately after intubation to make sure the tip of the tube is positioned in the middle of your trachea.
• The doctor listens to your lungs to make sure that they are being inflated.
• The level of gases in your blood is measured to make sure that the ventilation is working.
• You will not be able to eat, drink, or talk until the endotracheal tube is removed.

How Long Will It Take?

The process of intubation and connecting to a ventilator usually takes less than five minutes.

Will It Hurt?

The anesthesia will prevent you from feeling pain during the procedure. However, the tube can be uncomfortable and it may make you cough. It may also cause irritation to your voice box and trachea. Some patients will be given intravenous sedation so that they are not fully conscious during (and after) the procedure.

Possible Complications

Potential complications of intubation and mechanical ventilation include:

• Damage to teeth, lips, or tongue when endotracheal tube is inserted
• Damage to trachea, resulting in pain, hoarseness, and sometimes difficulty breathing after the endotracheal tube is removed
• Esophageal intubation (when the tube is accidentally inserted into the esophagus, which leads to the stomach, instead of the trachea)
• Movement of the tube down into one of the bronchi
• Low blood pressure
• Pneumonia
• Lung injury
• Collapsed lung (pneumothorax)
• Infection

Average Hospital Stay

The length of hospital stay associated with intubation and mechanical ventilation depends on the reason for having the procedure. It may be just a few hours for someone having anesthesia as part of an outpatient operation, or much longer for someone who requires life support.

Postoperative Care

Your doctor will check how well you are breathing before removing the tube. You need to:

• Be breathing on your own through the tube, without the ventilator attached. You may only be partially awake during this time.
• Have a satisfactory score on the Weaning Index, which measures how often you take a breath, how well you are oxygenating your blood, and how much air you breathe in and out.