What Does It Mean to Be Intubated?

Being intubated means a tube has been placed inside your trachea, also called the windpipe, through the mouth or nose.

There are several reasons you may be intubated. The main reason for intubation is to keep your airways open in an emergency setting and surgeries, so that oxygen, medication, or anesthesia can get into your lungs. The tube may be attached to a ventilator, a machine that helps you breathe.

How Intubation Works

You can be intubated either through your nose or mouth. Either scenario would be referred to as endotracheal intubation. More specifically, intubation through the mouth is called orotracheal intubation, and intubation through the nose is called nasotracheal intubation.

Healthcare providers may choose orotracheal or nasotracheal intubation depending on the condition of the patient and the procedure being performed.

Through the Mouth

Orotracheal intubation, or intubation through the mouth, is more common. The method is quicker and easier and will cause less pain than passing the tube through the nose.

Whether or not you are awake for the procedure, you will be given medication to make the tube’s insertion easier and more comfortable. If you are awake, you might also be given anesthetics to get you to sleep.

After you've been sedated, a healthcare provider will insert a laryngoscope into your mouth. A laryngoscope is an instrument with a light at the end and sometimes a small camera that helps the healthcare provider see your vocal cords. When vocal cords are visualized, the endotracheal tube is placed through your mouth and down your throat.

Healthcare providers check for proper placement of the tube after insertion through methods including chest X-rays, ultrasound, and different clinical assessments.

Through the Nose

In nasotracheal intubation, the tube is passed from your nostrils, into the nose, and then down the throat.

Nasal intubation is usually performed by first putting an anesthetic agent and a substance that constricts blood vessels into the nose. A tube is then inserted into the trachea through your nose.

You are more likely to be awake if you are getting intubated through the nose. That’s because keeping you awake helps some of the breathing reflexes stay intact during intubation. If you're awake, compared to oral intubation, nasal intubation makes you gag less and is typically better tolerated. For these reasons, a healthcare provider may choose nasal intubation if they think intubation through the mouth has a greater risk of compromising your airway.

A healthcare provider may also choose intubation through the nose over the mouth if they need access to your mouth. This includes dental surgeries as well as surgeries involving the mouth.

Why Would a Person Need to Be Intubated?

Intubation can be a life-saving procedure in emergency settings. You may be intubated for a number of reasons, including:

• Keeping the airways open so that you can receive oxygen, medication, or anesthesia
• Supporting breathing if you have severe trauma or a collapsed lung
• Supporting breathing if you have certain conditions like pneumonia, emphysema, or heart failure
• Removing an object that is blocking the airway
• Giving your healthcare provider a better look at the upper airway
• Protecting your lungs if you are unable to and there’s a risk of breathing in fluid (such as the case with overdose and some strokes)

Who Shouldn't Be Intubated?

Healthcare providers look at several factors before intubating. In some cases, intubation might be riskier. Such is the case with severe facial and head injuries, where bleeding or the alteration of the anatomy can make intubation challenging. Handling of the spine during intubation can also be harmful to people who have any spine injury.

For people who might have a greater risk for adverse events during intubation, healthcare providers will weigh the benefits and risks and determine whether a different form of ventilation is acceptable.

What to Expect

Intubation is often an emergency procedure, so there is nothing you can really do beforehand to prepare.

Once you are taken off of intubation, your healthcare team will monitor your breathing and your blood oxygen levels. You may be placed on oxygen or a breathing machine. You may also be given medication to help with any anxiety or discomfort you may have.

Intubation Risks

Healthcare providers will assess whether a less invasive procedure would be effective. Oftentimes in emergency situations, intubation is considered the best route even though it may come with risks like:

• Low levels of oxygen in the blood in the case of a failed intubation or misplaced tube
• Problems with the heart due to medications that are used before the intubation
• Abnormally slow heart rate due to stimulation of the vagus nerve during the procedure 
• Abnormally low blood pressure from sedatives 
• A puncture or tear where the tube is passed
• Bleeding, such as from the nose
• Injury to your teeth
• Breathing in vomit or objects like dentures
• Infection

Being Intubated vs. Being on a Ventilator

Being intubated and being on a ventilator are similar in that both processes help you breathe—and they may even be connected—but there are differences. 

Being intubated means that there is a tube that is inserted into your windpipe—either through your mouth or your nose—to open and protect your airways. Being on a ventilator means you are hooked up to a machine that moves air in and out of your lungs. 

You can be hooked up to a ventilator with a face mask or an endotracheal tube. You’d need to be put on a ventilator if you have a condition that makes it hard for you to breathe. As your breathing improves and you don’t need as much support, the ventilator support will be turned down until you no longer need it.

A Quick Review

Intubation is a process that involves the insertion of a tube called an endotracheal tube either through your mouth or nose. Intubation is usually a life-saving procedure in emergency settings and is performed by a team of healthcare providers including doctors, anesthetists, and nurses. Intubation can keep airways open and help deliver oxygen, medication, or anesthesia. The tube might be hooked to a ventilator to help you breathe. Different drugs and anesthetics are usually given before you are intubated to make the process easier and more comfortable. There are some risks associated with intubation, but they will be weighed against the benefits.