by Endotracheal intubation, commonly known as placing a breathing tube or Endotracheal Tubedown into the trachea, is a lifesaving procedure performed in hospitals worldwide. The endotracheal tube, or ET tube, provides a clear pathway into the lungs allowing critical care physicians to effectively ventilate and oxygenate patients when they are unable to breathe on their own. In this article, we will explore the anatomy and function of the endotracheal tube as well as key factors involved in its appropriate usage.
What is an Endotracheal Tube?
An endotracheal tube is a hollow, thin, flexible plastic tube inserted through the mouth or nose down into the trachea (windpipe). It has an inflatable cuff near its tip that seals the tube in place and prevents air from leaking up and out of the trachea when the patient is ventilated. The tube comes in varying diameters depending on the age and size of the patient. Standard tubes are typically 8.0-9.0 mm internal diameter for adults. Various specialized tubes also exist such as double lumen tubes used during certain surgeries.
Endotracheal Tube Anatomy and Function
The tube is divided into three main sections – the distal tip, body, and proximal end. The distal tip is rounded and flexible to help guide it smoothly down the trachea without causing damage. About 1-2 cm from the tip is the cuff, a thin balloon-like structure that inflates once placed to seal the airway. The main body of the tube continues up through the vocal cords and into the mouth/nose. It is transparent allowing visualization of secretions and effectiveness of suctioning. The proximal end has connectors for ventilator circuits, suction catheters and tubes for gastric decompression. ET tubes precisely deliver oxygen, monitor exhaled carbon dioxide, allow suctioning and support respiration during procedures when the patient cannot breathe independently.
Indications for Endotracheal Intubation
There are several medical conditions where Endotracheal Intubation may be necessary including airway obstruction, respiratory failure or respiratory arrest, impaired airway protective reflexes, and certain surgical procedures requiring general anesthesia with paralysis. Common scenarios include severe asthma exacerbations, chronic obstructive pulmonary disease (COPD) exacerbation, pulmonary edema, drug overdoses, traumatic injuries and during cardiac arrest resuscitations. The American Society of Anesthesiologists also provides guidelines on appropriate intubation indications. Proper patient selection and clinical circumstance is important to avoid unnecessary trauma from the procedure.
Risks and Complications of Endotracheal Intubation
While endotracheal intubation is often lifesaving, it does carry some risks including airway trauma from multiple attempts or use of excessive force, esophageal intubation where the tube is inadvertently placed in the esophagus instead of trachea, aspiration of gastric contents around the tube, and ventilator-associated pneumonia. Other possible complications are subglottic stenosis, laryngeal injury such as vocal cord paralysis and laryngeal edema. Ensuring tube placement is confirmed, careful technique and utilization of alternate airway devices when appropriate can help mitigate these risks. Proper nursing care is also important post-intubation to prevent additional issues.
Nursing Care and Monitoring after Intubation
Once the endotracheal tube is placed, nurses play a vital role in ongoing care and monitoring the intubated patient. This includes assessing tube placement with each breath sound assessment, securing the tube to prevent accidental dislodgment, inflating the cuff to appropriate pressure, documenting cuff pressures regularly, providing oral hygiene, assessing for signs of lung infection and making sure sedation levels are appropriately titrated daily for attempts at weaning when indicated. Nurses communicate changing patient status promptly to the respiratory therapist and physician for interventions like adjusting ventilator settings, suctioning secretions, or repositioning the tube if needed. Close monitoring is essential to optimize patient safety and outcomes with an endotracheal tube in place.
Advancements in Endotracheal Tube Technology
Endotracheal tubes continue to evolve with technological advancements focused on enhancing patient comfort and safety. Laser-marked tubes allow for precise depth placement under direct visualization. Newer cuff designs incorporate polyurethane material for a softer seal and reduce risks of mucosal damage. Select tubes now come pre-mounted on a flexible guiding stylet to aid straight tracheal passage rather than older rigid stylets. Some incorporate subglottic suctioning ports above the cuff to actively drain secretions and decrease ventilator-associated pneumonia incidence. Further research aims to reduce tubing diameter and introduce antimicrobial coatings to decrease complications. These innovations exemplify the dynamic progress within critical care capabilities.
Endotracheal intubation with placement of an endotracheal tube is an essential lifesaving technique employed routinely in critical care settings. From selecting appropriate patients to meticulous nursing care, a multi-disciplinary team approach is vital for optimal tube management and reducing procedure risks. Continued advances enhance this fundamental airway management modality. With appropriate indications, techniques and monitoring, endotracheal tubes play an invaluable role in supporting patients unable to breathe independently.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it
