Let's learn about the tube that is inserted when someone has difficulty breathing? (Intubation)

You've probably heard the phrase "putting in a tube" or "putting in a tube" when someone is in a critical condition, or before a major operation . What does this actually mean? While it may sound a little scary, it's a very important thing that can often save a life. Let's just talk about it, okay?

What is intubation?

Simply put, intubation is when a doctor or trained health care professional inserts a thin tube through your mouth (or sometimes your nose) into your windpipe (the main airway). This is also called endotracheal intubation or tracheal intubation . When this tube is inserted, the windpipe is open, making it easier to breathe. This tube can then be connected to a machine (often a ventilator ) that can breathe for you. The machine then provides oxygen and air to help you breathe.

Why would someone need to be intubated like this?

A tube is only needed if someone is unable to breathe properly on their own, or if their airway is blocked or damaged. Think about it, oxygen is essential for our bodies. So if we don't get it properly, a lot of problems can occur.

These are the situations in which a tube is usually inserted:

• Airway obstruction: Imagine if something got stuck in your airway, like a piece of food, and you couldn't breathe. That's how it is.
• Cardiac arrest: If the heart stops working suddenly , oxygen is not getting to the brain and other organs. This method is used to quickly breathe at that time.
• Severe injuries to the neck, chest, or abdomen: These injuries can affect the airway and make it difficult to breathe.
• Loss of consciousness or reduced level of consciousness: When someone loses consciousness, they may not be able to control their breathing. This means that the tongue may fall back and choke.
• During major surgery: During some major surgeries, you will be under anesthesia and will not be able to breathe on your own. At that time, this tube will be used to help you breathe until the surgery is over.
• Respiratory failure or temporary cessation of breathing (Apnea): In cases of severe lung infections like pneumonia or exacerbation of asthma, the lungs cannot function properly. Even then, support is needed in this way.
• Risk for substances such as food, vomit, or blood entering the airway aspiration : If someone is unconscious, things can go into the lungs when they vomit. That's very dangerous. This tube helps prevent that.

Are inserting a tube and connecting it to a ventilator the same thing?

These two are related, but not exactly the same thing.

Intubation, as we discussed earlier, refers to the process of inserting a tube (Endotracheal tube - ETT) into the trachea.

Then, through this tube, you are connected to a breathing device. This can sometimes be a bag that a doctor squeezes and blows air into (you may have seen it in the movies). Or, you are connected to a machine called a `Ventilator` . This machine is what sends oxygen and air into the lungs in a controlled manner.

However, sometimes the ventilator gives breaths through a mask that covers the mouth and nose. Then a tube is not inserted. That's a different thing.

Who cannot have a tube inserted this way? (Contraindications)

While this can be done safely in most cases, there are times when doctors decide it is not safe to insert a tube this way. For example:

• If the airway is severely damaged.
• If there is a major obstruction in the trachea that prevents the tube from being inserted.

Imagine, if there's been a major accident in the neck area and the trachea has been severed, trying to put a tube through it could cause even more damage, right?

In such cases, doctors use a different method. That is, they make a small hole in the lower part of the neck, directly into the windpipe, and breathe through it. This is called a `tracheostomy` . This `tracheostomy` is also necessary when a tube needs to be left in place for more than a few days, sometimes even weeks. This is because having a tube inserted through the mouth or nose for a long time can cause other problems.

How does this tube placement procedure work?

This is usually done in a hospital. In an emergency, this can be done before the ambulance service takes you to the hospital. However, this is done by trained doctors and health staff.

Here's what usually happens:

1. Preparation: First, a small needle (like an `IV needle`) is inserted into a vein in your arm and the necessary medication is given through it. This is how anesthesia is given to make you sleepy and not feel any pain.

2. Supplemental oxygen: Next, an oxygen mask is placed over your mouth and nose to provide a small amount of supplemental oxygen to your body. This is done to prevent oxygen depletion during the short time the tube is in place.

3. Insertion of the device: The oxygen mask is then removed, your head is tilted back slightly, and a special device called a laryngoscope is inserted into your mouth (sometimes through your nose). It has a small light and a mirror-like part. This allows the doctor to see the windpipe better and insert the tube.

4. Making the trachea visible: This device is slowly moved from inside the mouth to the back, and without touching the teeth, the part of the throat called the epiglottis (this is like a small lid that closes the trachea when we swallow food) is lifted, making the mouth of the trachea clearly visible.

5. Insertion of the tube: Next, the tip of the laryngoscope is passed through the mouth of the trachea into the trachea, and the breathing tube (endotracheal tube) is inserted along it.

6. Stabilizing the tube: After the tube is inserted, a small balloon-like part around it is inflated to make it larger. This way, the tube stays in the trachea without moving, and all the breath you breathe in goes into the lungs and doesn't come out.

7. Removing and attaching the device: The laryngoscope is then removed and the tube is secured to the side of the mouth with a plaster or a headband to prevent it from moving.

8. Checking for correct placement: Finally, the tube is checked to see if it is in the trachea or has gone somewhere else. This can be done with a chest X-ray , or by attaching a bag to the tube and inflating it with air, and listening to the chest with a stethoscope to see if there is any breathing sound.

All of this will only take a few minutes, but it needs to be done very carefully and quickly.

Can you talk and eat while you have a tube in place?

This is a problem for many people.

• You can't speak: Because the tube goes between your vocal cords (the part that vibrates when you speak), you can't speak while you have a tube in place.
• You can't eat or drink: Also, you can't swallow while you have a tube in place. So you can't eat or drink.

You may wonder, "How will you provide food then?"

Typically, depending on how long you will be on this tube, doctors will give you the nutrition you need either through saline (`IV fluids`) or as liquids through a separate thin tube that is inserted through your mouth or nose into your stomach.

How do you remove a tube? (Extubation)

When the doctors decide that you can breathe well on your own and that you don't need this tube anymore, they remove it. This is called ``Extubation .'' This is also a very simple procedure.

Here's how:

1. First, remove the plaster or tape that holds the tube in place.

2. Then, unnecessary mucus and other things in the respiratory tract are removed with a fine tube (suction).

3. The small balloon that was inflated to keep the tube from getting stuck inside the trachea is deflated.

4. Then, the doctor will tell you to take a deep breath, cough loudly, and hold your breath. At that point, they will slowly pull the tube out.

After the tube is removed, your throat may be sore for a few days. You may also feel a little uncomfortable when talking. But that will go away in a few days.

Are there any risks to this? (Risks of Intubation)

Insertion of a tube is a common, largely safe, and potentially life-saving procedure. Most people recover within a few hours or days. However, there are some complications that can occur very rarely:

• Aspiration: When a tube is inserted or left in place, sometimes things like vomit and blood can enter the lungs.
• Pipe going in the wrong place:
• Endobronchial intubation: Sometimes the tube can only go into one of the two main airways that branch off from the trachea into the lungs (also called mainstem intubation). Then only one lung is breathing.
• Esophageal intubation: If the tube goes into the food pipe, the esophagus, instead of the windpipe , it can cause brain damage and even death if not recognized quickly. But doctors are very careful about this.
• Failure to secure the airway: Sometimes attempts to insert a tube may not be successful, making it impossible to treat the patient.
• Infections: People with tubes can sometimes develop things like sinus infections.
• Injury: When a tube is inserted, there may be minor injuries to the mouth, teeth, tongue, vocal cords, or airway. This can cause bleeding and swelling.
• Problems with anesthesia: Although most people recover well from anesthesia, some may experience delayed recovery or other emergencies.
• Tension pneumothorax: A condition in which air is trapped inside the chest cavity, causing the lungs to collapse.

Although these risks exist, they are very small compared to the benefits of having a tube inserted, especially in a life-saving situation.

Finally, things to remember (Take-Home Message)

I hope you now have a good understanding of Endotracheal intubation , or endotracheal intubation. This is a very important medical procedure that is performed to save a person's life when they are unable to breathe on their own.

This tube keeps the windpipe open and allows oxygen to enter the lungs.

This is usually done in a hospital, in an emergency, or before a major surgery. Although it may seem a little scary, it is done to help you recover. Trust that your doctor will always do what is best for you. If you have any questions or concerns, don't be afraid to ask your doctor or nurse.

` intubation, trachea, insertion of a tube, ventilator, breathing, surgery, emergency treatment