What is the use of endotracheal intubation?

Question

i understand this method apply during giving resuscitation to neonates or adults.. but i don't see the use of this method..

positive pressure is giving the air, chest compression give stimulation to heart ..

Answer 1

intubation guarantees an airway.

its the only way to make sure you have an airway in an unstable situation. if the patient vomits during resuscitation no vomitus can enter the lungs.

its for patients who cannot protect their own airway due to anesthesia, allergic reaction, trauma, or altered level of consciousness.

basically if your patient is properly intubated, you don't have to worry about their airway worsening.

it doesn't matter if their heart is beating if they're not getting any oxygen to go through their system, and vice versa.

edit:

its used to ensure that the oxygen you're resuscitating them with gets to their lungs, and not their stomach, or leaked out due to a bad face/mask seal. the more oxygen gets to the alveoli the more gets into their blood.

the tube stays in the airway with the help of an inflatable cuff on the outside of the tube. if you've never seen one, think of the e.t. tube as a straw, and the inflatable cuff as a bubble that goes around the straw to seal any air from escaping the lungs during your positive pressure ventilations. pediatric tubes do not have a cuff.

the tube can be removed easily by deflating the cuff and removing the tube. they aren't really for use in conscious patients, though in ems it is recommended to keep the tube in even if the patient has regained consciousness.

Answer 2

I've got nothing additional to add at this point, just want to emphasize that the above posters are absolutely right.  I've intubated a number of patients myself, and it is an excellent way to manage an airway.

Answer 3

A endotracheal tube "ETT" is used for many reasons and is sometimes left in place for many weeks. Years ago they had high pressure low volume cuffs and could only be kept in for a couple of days without risking necrosis and tracheostomys were often done, but since the 80's they use low pressure high volume cuffs and so are often kept in longer before resorting to a tracheostomy.

I work at a major pediatric trauma and transplant center in the US and so our practice might not be the same as centers with different patient populations.

I will contradict Chrissy on three points

1. The purpose of the cuff is not to keep the ETT in place. It is quite easy to remove an ETT with the cuff inflated, but this causes airway trauma and should never be done. The purpose of the cuff is to seal the airway so as to allow for positive pressure ventilation without leaks. The ETT is actually kept in place either by taping it to the face or by the use of head gear.

2. The anatomy of the pediatric airway USUALLY negates the need for a cuffed ETT, but pediatric tubes often do have a cuff. ETT come in "French" sizing. I commonly use ETT's in sizes from 2.5 to 7.0. The ETT's we use at our facility have both cuffed and uncuffed versions for sizes 3.0 to 6.0. I often use a cuffed ETT in children for specific reasons.

3. ETT's are often used in conscious patients. I have had hundreds of patients over the years sitting up in bed reading books and watching TV with an ETT hanging from their mouth or nose while we weaned the vent settings to a point where the ETT could be safely removed.

In the field you often don't need to intubate as BVM is adequate, but if lung compliance becomes an issue or pulmonary edema ensues maintaining effective BVM can become problematic. Try bagging at a PIP of 40 and a PEEP of 10 for 30 minutes of BVM in a bouncing ambulance and you will soon see the advantage of an ETT.

Answer 4

I assume you are referring to arrest situations.  There are numerous indications outside of that scenario.

During a "code"

1.  Airway protection.  Unconscious people vomit and aspirate. I've seen that more than once in arrests.  It's ugly.

2.  Ability to give 100% oxygen to the lungs without inflating the stomach.

Remember the basics of resuscitation:  A-B-C

AIRWAY, Breathing, Circulation

An endotracheal tube is the ultimate airway.

EDIT for lampoilman:  ETT are NOT French sized - the size is the internal diameter of the tube in millimeters.  Otherwise, great info. :D

JdW:  You can keep the vomit in the ED!

Answer 5

It's the best way to control the airway. When you get from theory to the real world, it'll become apparent very quickly. There's nothing like a resuscitation on somebody who's overeaten just before he crashed, with vomit everywhere, including the trachea and bronchi. Moreover, the seal on the mask when doing BVM is a bigger real-world problem than you might think. And finally, resuscitations only end with the patient walking away when they're on TV. In real life, the patient's almost certainly going to be on a ventilator, where the tube will be a must.