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Intubation – Procedure, Uses & Risks

Intubation is the medical procedure of inserting a breathing tube into the trachea to secure the airway. It is a key technique in emergency medicine and anaesthesia.

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Intubation is the medical procedure of inserting a breathing tube into the trachea to secure the airway. It is a key technique in emergency medicine and anaesthesia.

What Is Intubation?

Intubation – or more precisely endotracheal intubation – is a medical procedure in which a flexible plastic tube called an endotracheal tube is inserted through the mouth or nose into the trachea (windpipe). The primary goal is to secure and control the airway when a person is unable to breathe adequately on their own.

When Is Intubation Performed?

Intubation is performed in a variety of clinical situations, including:

General anaesthesia: Patients undergoing surgery under general anaesthesia are typically intubated to maintain an open airway and allow controlled mechanical ventilation.
Emergency medicine: In cases of cardiac arrest, severe respiratory failure, unconsciousness, or shock, intubation can be life-saving.
Intensive care: Critically ill patients who cannot breathe independently are mechanically ventilated through an endotracheal tube.
Aspiration prevention: Unconscious patients are intubated to prevent the inhalation of stomach contents (aspiration).

How Is Intubation Performed?

Intubation is typically carried out by trained medical professionals such as anaesthesiologists or emergency physicians. The standard procedure includes the following steps:

Preparation

The patient is placed in the supine position with the head slightly extended into the so-called sniffing position. Supplemental oxygen is often administered beforehand (pre-oxygenation) to increase blood oxygen levels and provide a safety margin during the procedure.

Medication

In controlled settings such as induction of anaesthesia, sedatives, analgesics, and neuromuscular blocking agents (muscle relaxants) are administered to facilitate tube placement and ensure patient comfort and safety.

Tube Insertion

Using a laryngoscope – a lighted instrument used to visualise the entrance to the larynx – the tube is guided into the trachea under direct vision. Video laryngoscopy, which uses a camera to aid visualisation, is increasingly used in difficult airway scenarios.

Confirmation of Placement

After insertion, correct tube placement must be confirmed through methods such as auscultation of breath sounds, capnometry (measurement of exhaled carbon dioxide), or chest X-ray. The tube is then secured and connected to a ventilator or bag-valve device.

Types of Intubation

Orotracheal intubation: Tube inserted through the mouth – the most common method.
Nasotracheal intubation: Tube inserted through the nose – used in specific oral or maxillofacial surgical procedures.
Blind intubation: Insertion without direct visualisation – rarely used today.
Fibreoptic intubation: Uses a flexible endoscope – indicated for difficult airways due to anatomical variations.

Potential Risks and Complications

As an invasive procedure, intubation carries certain risks and potential complications:

Trauma to teeth, lips, pharynx, or vocal cord structures
Oesophageal intubation (accidental tube placement into the oesophagus instead of the trachea)
Aspiration pneumonia
Pressure injuries or circulatory damage to airway structures during prolonged ventilation
Ventilator-associated pneumonia (VAP) in long-term intubated patients

Extubation

Extubation refers to the removal of the endotracheal tube once the patient is able to breathe independently again. This step is carried out under close monitoring, as airway complications can occur immediately after tube removal.

References

Tintinalli JE et al. – Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 9th Edition. McGraw-Hill Education, 2020.
Apfelbaum JL et al. – Practice Guidelines for Management of the Difficult Airway. Anesthesiology, American Society of Anesthesiologists (ASA), 2022.
World Health Organization (WHO): Surgical Safety Checklist and Safe Surgery Guidelines. WHO Press, Geneva.

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