What are the indications for intubation?

Question

What are the indications for intubation?

Answer 1

The main indication for intubation is airway protection / control of airway: when in doubt intubate! Such circumstances may be:

1.   Loss of gag/cough reflex e.g. severe head injury

2.  Airway obstruction: acute laryngeal edema – e.g. inhalation burn, Ludwig’s angina, epiglottitis.

3.  Anticipated loss of control of the airway: anticipated laryngeal edema– e.g. neck trauma, acute stridor etc.

Patients are usually intubated for controlled mechanical ventilation as an endotracheal tube or tracheostomy will provide a good seal for controlled ventilation: inspired volumes and pressures are consistent; compared with non invasive methods. Finally, the presence of an artificial airway facilitates removal of obstructive material from the airway (airway toilet – suctioning of secretions).

Answer 2

The easy answer is

1. apnea

2. respiratory failure

3. impending respiratory failure

4. protection to maintain a patent airway

Pretty much every situation boils down to one of these indications.

Answer 3

Inability to protect one's airway from aspiration.

Inability to maintain adequate oxygenation despite supplemental oxygen.

Inability to maintain ventilation (weakness, tiring from increased work of breathing)

Many surgical procedures require intubation, and that depends on too many factors to list here.

(Sat's below 90% on NRB do not necessarily require intubation - sometimes CPAP or BiPAP will work for those pts.)