intubations

Intubation is the placement of a tube into the airway to secure breathing and enable ventilation. The most common form is endotracheal intubation, where an endotracheal tube is inserted through the mouth or nose into the trachea. It may also be achieved by tracheostomy or other airway devices when needed.

Indications include airway obstruction, risk of aspiration, respiratory failure, and the need for controlled ventilation during anesthesia or critical illness. Common approaches are orotracheal intubation and nasotracheal intubation. When aspiration risk is high, rapid sequence intubation using sedatives and neuromuscular blockers may be used. Awake intubation may be chosen in anticipated difficult airways.

Equipment and technique: a laryngoscope to visualize the glottis, an endotracheal tube with a cuff, a stylet, suction, and a bag-valve mask. Video laryngoscopy and fiberoptic scopes are used in difficult cases. After intubation, placement is confirmed with capnography and clinical signs, and the tube is secured before initiating ventilation.

Complications include dental or airway trauma, misplacement (such as esophageal intubation), hypoxemia, airway injury, bronchospasm, aspiration, infection, and hemodynamic instability. Proper preoxygenation, gentle technique, and careful monitoring mitigate risk. Extubation and weaning from mechanical ventilation require assessment of readiness and airway protection.

Alternatives and advances include supraglottic airway devices (such as laryngeal mask airways), and flexible fiberoptic intubation for difficult airways. In pediatrics and neonates, anatomical differences require specialized techniques and equipment. The choice of method depends on the clinical context, patient anatomy, and provider expertise.