• 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 trachea (windpipe), resulting in pain, hoarseness, and sometimes 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
    • Infection
    Some factors that may increase the risk of complications include:
    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.
    The doctor will tilt your head back slightly. Then, the doctor will use a tool called a laryngoscope. The scope has a handle, a light, and a smooth dull blade. This tool is used to lift the tongue off the back of the throat so the doctor can see your vocal cords. When the doctor sees your vocal cords, he will stick one end of the breathing tube through them, down into your lower windpipe.
    Once the tube is in position, the doctor will remove the scope and leave the tube in place. The tube will then be taped to the corner of your mouth. Next, the doctor will attach the tube to a ventilator machine. 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:
    • Do a chest x-ray to make sure the tip of the tube is positioned in the middle of your trachea
    • Listen to your lungs to make sure that the air is going into them
    • 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 make you cough. It may also irritate your voice box and trachea.

    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 endotracheal tube is removed. Before the doctor can remove the tube, 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 a satisfactory score on the Weaning Index, which measures:
      • 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
    • Develop a cough
    • Signs of infection, like fever or chills
    • A tendency to breathe in your food or drink
    • Musical sounds when you breathe (called 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/index-eng.php

    References

    Beers, MH, Fletcher AJ, Jones TV, et al. The Merck Manual of Medical Information. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories; 2003.

    Kasper DL, Harrison TR. Harrison’s Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005.

    Mason RJ. Murray and Nadel's Textbook of Respiratory Medicine. 4th ed. Philadelphia, PA: WB Saunders; 2005.

    Mechanical ventilation. Anaesthesia & Intensive Care website. Available at: http://www.aic.cuhk.edu.hk/web8/mech%20vent%20intro.htm. Updated May 2009. Accessed July 28, 2009.

    Roberts JR. Clinical Procedures in Emergency Medicine. 4th ed. Philadelphia, PA: WB Saunders; 2004.

    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.

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