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Intubation and Mechanical Ventilation

Definition

Intubation is placing a tube in your throat to help move air in and out of your lungs. Mechanical ventilation is the use of a machine to move air in and out of your lungs.
Endotracheal Intubation
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Reasons for Procedure

Many different injuries or illnesses can make it difficult for you to breathe. If you cannot move enough air in and out of your lungs you will need support. This is often an emergency.
It may also be used as support during surgery. Anesthesia medicine can suppress breathing. Ventilation will support your breathing until medicine has worn off.

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
  • Damage to teeth, lips, or tongue
  • Damage to the trachea or voicebox 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
  • Too little or too much ventilation
  • Pneumonia
  • Lung injury/collasped lung
  • Infection
Some factors that may increase the risk of complications include:
When possible talk to your doctor about these risks 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

It will usually require:
  • Heavy sedation—barely awake, generally not aware
  • General anesthesia —you will be asleep
Other options include:
  • Local anesthesia—to numb your throat.
  • Muscle relaxant—to prevent gagging when the tube is inserted

Description of the Procedure

First, you will wear an oxygen mask for two to three minutes. This will boost the oxygen in your body.
For intubation:
Your head will be tilted back slightly. A scope with a handle, light, and a smooth dull blade will be used. This tool opens the airways so the doctor can see deep in the throat. One end of a breathing tube will be passed through the airway. It will be passed into your lower windpipe.
When the tube is in position, the scope will be removed. The tube will be secured. The doctor will check to make sure air can move into both lungs.
For ventilation:
A flexible tube will be attached to the breathing tube. The flexible tube is connected to the ventilator. This machine will move air in and out of your lungs. It can adjust how quickly and how deeply you breathe. Some ventilation can be done with a tube inserted through the nose instead of the mouth.

Immediately After Procedure

Right after the procedure, your doctor will:
  • Listen to your lungs. To help make sure that the air is moving to both lungs.
  • Do a chest x-ray . To make sure the tip of the tube is in the right place.
  • Measure the level of gases in your blood. To make sure enough air is moving as it should.

How Long Will It Take?

It will take less 5 minutes to put the breathing tube in. Your time on the ventilator will depend on your needs.

How Much Will It Hurt?

Anesthesia will prevent pain during the procedure. The tube will cause some discomfort. It may also make you cough.
You may have a sore throat after the tube is removed. It should pass in a few days.

Average Hospital Stay

The length of stay will depend on why you needed support.

Post-procedure Care

You will not be able to eat, drink, or talk until the tube is removed. You will receive extra help from your care team.
The tube will be removed if:
  • You can effectively breathe on your own.
  • You 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.
A tracheotomy may be needed if you need support for more than a few weeks. This is an opening made in the front of your neck.

Call Your Doctor

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:
  • Difficulty breathing
  • Coughing
  • Signs of infection, like fever or chills
  • Breathing in your food or drink
  • Musical sounds when you breathe, known as stridor
  • You have a persistently hoarse voice
If you think you have an emergency, call for emergency medical services right away.

RESOURCES

American Lung Association
http://www.lung.org
Asthma and Allergy Foundation of America
http://www.aafa.org

CANADIAN RESOURCES

Health Canada
https://www.canada.ca
The Lung Association
http://www.lung.ca

References

Mechanical ventilation. Anaesthesia & Intensive Care website. Available at: http://www.aic.cuhk.edu.hk/web8/mech%20vent%20intro.htm. Accessed August 29, 2018.
Mechanical ventilation. American Thoracic Society website. Available at: http://www.thoracic.org/patients/patient-resources/resources/mechanical-ventilation.pdf. Accessed August 29, 2018.
Explore ventilator/ventilator support. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/vent. Accessed August 29, 2018.

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