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Intubation and Mechanical Ventilation

Definition

Intubation and mechanical ventilation is the use of a tube and a machine to help get air into and out of your lungs. This is often done in emergencies, but it can also be done when you are having surgery.
Endotracheal Intubation
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Reasons for Procedure

Your lungs help exchange gases in your body. Oxygen is moved from the air in your lungs into your blood, and carbon dioxide in your blood moves into the air in your lungs. This movement of gases is needed to live. If you cannot move air into and out of your lungs, then this gas exchange cannot happen. Intubation and mechanical ventilation is done to help you breathe when you cannot move enough air in and out on your own.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have intubation and mechanical ventilation, your doctor will review a list of possible complications, which may include:
  • Damage to teeth, lips, or tongue
  • Damage to the trachea or larynx resulting in pain, hoarseness, or difficulty breathing after the tube is removed
  • Esophageal intubation—when the tube is accidentally inserted into the esophagus and stomach rather than the trachea
  • Low blood pressure
  • Pneumonia
  • Lung injury/collasped lung
  • Infection
Some factors that may increase the risk of complications include:
  • Smoking
  • Neck or cervical spine injury
  • Pre-existing lung disease such as emphysema
  • Poor condition of teeth
  • Recent meal
  • Dehydration
  • Diseases that cause muscle weakness such as myasthenia gravis
Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

If your intubation and mechanical ventilation is being performed along with surgery and is planned:
  • The night before, eat a light meal. Do not eat or drink anything after midnight.
  • Ask your doctor about any other special directions.

Anesthesia

In most cases, you will either be heavily sedated or under general anesthesia and asleep. Local anesthesia may be used to numb your throat. You may also receive a muscle relaxant. This is to prevent gagging when the tube is inserted.

Description of the Procedure

First, you will wear an oxygen mask for 2-3 minutes. This will ensure that you have enough oxygen in your system during the procedure.
Your head will be tilted back slightly. A tool called a laryngoscope will be used. The scope has a handle, a light, and a smooth dull blade. This tool lifts the tongue off the back of the throat so your vocal cords can be seen. One end of the breathing tube will be inserted through the vocal cords and into your lower windpipe.
When the tube is in position, the scope will be removed and the tube will be left in place. Next, the tube will be attached to a ventilator machine. The tube will then be taped to the corner of your mouth. This machine will move air in and out of your lungs. It can adjust how quickly and how deeply you breathe. In some cases, the tube will be inserted through the nose instead of the mouth.

Immediately After Procedure

Right after the procedure, your doctor will:
  • Listen to your lungs to make sure that the air is going into them
  • Do a chest x-ray to make sure the tip of the tube is positioned in the middle of your trachea
  • Measure the level of gases in your blood to make sure that the ventilation is working

How Long Will It Take?

Less than five minutes

How Much Will It Hurt?

The anesthesia will prevent pain during the procedure. The tube will cause discomfort and may make you cough.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay depends on why you are having the procedure.

Post-procedure Care

While you are intubated, you will receive extra help from nurses and other hospital staff.
You will not be able to eat, drink, or talk until the tube is removed. Before the tube can be removed, you will need to:
  • Be breathing on your own through the tube, without the ventilator attached. You may only be partially awake during this time.
  • Have made progress in:
    • How often you take a breath
    • How well oxygen is getting into your blood
    • How much air you breathe in and out each time you take a breath
  • If you need mechanical ventilation for more than a few weeks, a tracheotomy may be done. In this case, the airway tube is inserted through a hole made in your neck instead of your mouth or nose.

Call Your Doctor

After you are no longer intubated and have left the hospital, contact your doctor if any of the following occurs:
  • Difficulty breathing
  • Coughing
  • Signs of infection, like fever or chills
  • Breathing in your food or drink
  • Musical sounds when you breathe, known as stridor
In case of an emergency, call for medical help right away.

RESOURCES

American Lung Association http://www.lungusa.org

Asthma and Allergy Foundation of America http://www.aafa.org

CANADIAN RESOURCES

The Canadian Lung Association http://www.lung.ca

Health Canada http://www.hc-sc.gc.ca

References

Mechanical ventilation. Anaesthesia & Intensive Care website. Available at: http://www.aic.cuhk.edu.hk/web8/mech%20vent%20intro.htm. Accessed May 29, 2013.

Mechanical ventilator. American Thoracic Society website. Available at: http://www.thoracic.org/clinical/critical-care../patient-information/icu-devices-and-procedures/mechanical-ventilator.php. Accessed May 29, 2013.

What is a ventilator? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/vent/. Updated February 1, 2011. Accessed May 29, 2013.

6/3/2011 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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