Endotracheal intubation involves the placement of a flexible tube through the mouth into the trachea to assist patients who cannot breathe independently. The procedure is often used in emergencies and requires careful management to prevent complications such as tube obstruction, dislodgment, and injury. Continuous monitoring and supportive care are essential, including proper positioning, suctioning, and ensuring adequate oxygenation and nutrition.

2.  An endotracheal tube is a flexible plastic tube that is placed through the mouth
into the trachea (windpipe) to help a patient breathe. The endotracheal tube is
then connected to a ventilator, which delivers oxygen to the lungs. The process of
inserting the tube is called endotracheal intubation
 Endotracheal intubation (EI) is often an emergency procedure that's performed on
people who are unconscious or who can't breathe on their own.
 It is recommended that the endotracheal tube tip be fixed at 5cm above the
carina, with the head in a neutral position. That way, it can move 2cm up and 2cm
down, without the risk of exiting the cords or going down the right main bronchus.

4.  Oesophageal intubation
 Obstruction of the tube (be it kinked by teeth or clogged with phlegm)
 Dislodgement above the glottis (tube falling out)
 Endobronchial intubation (tube falling in)
 Cuff rupture, pressure loss
 Trauma due to intubation (eg. tracheobronchial injury, even perforation)
 Mucosal ulceration and necrosis from prolonged intubation

5. Respiratory failureApnea / respiratory arrest
 Inadequate ventilation(acute vs chronic)
 Inadequate oxygenation
 Chronic respiratory insufficiency with FTT
 COPD
 Airway obstruction
 Hypoventilation
 Severe hypoxemia

6. Cardiac insufficiency
 Eliminate the work of breathing
 To reduce the oxygen consumption
Neurologic dysfunction
 Impaired cognitive impairment
 Central hypoventilation and frequent apnea
 Comatose patient with GCS < 8
 Inability to protect the airway

7. ABG Results
If the patient is under the following conditions:
 Multiple trauma
 Shock
 Multi-organ failure
 Drug overdose
 Thoracic or abdominal surgery
 A long period of surgery
 Neuromuscular disorders
 Inhalation injury

8.  Ensure that the required oxygen support indicated for the patient is provided.
 Assess the client’s respiratory status at least every 2 hours or frequently as
indicated. Note the lung sounds and presence of secretions.
 Ensure that adequate humidity is provided to avoid feeling of dryness in the
oropharynx.
 Suction secretions orally to prevent aspiration. This also decreases the risk for
infection.
 Assess nasal and oral mucosa for redness and irritation.
 Secure the endotracheal tube with tape or ET holder to prevent movement or deviation
of the tube in the trachea.
 Place the patient in a side-lying position or semi fowler’s if not contraindicated to
avoid aspiration. Reposition patient every 2 hours. This will allow the lungs to expand
better and prevent secretions stagnation.

9.  Ensure the ET for placement. Note lip line marking and compare it with the desired
placement (18cm, 20cm, and 22cm).
 Closely monitor cuff pressure, maintaining a pressure of 20 to 25 mmHg to minimize
the risk of tracheal necrosis.
 Move the oral endotracheal tube to the opposite of the mouth every 8 hours or
depending on the protocol of the hospital. This is to prevent irritation to the oral
mucosa.
 Provide oral care at least every 4 hours using an antibacterial or antiseptic solution.
Use a bite block to avoid patient from biting down. Frequent oral care in intubated
patients will decrease the risk of ventilator-acquired pneumonia.
 Use a bite block to avoid patient from biting down.
 Turn patient’s head to the side to reduce the risk for aspiration.
 Communicate frequently with the client. Give patient means to communicate using a
whiteboard or communication board.

10.  Nutritional Consideration
Oral feeding is contraindicated. Enteral feeding is the route for nutritional support.
The most common route for enteral feeding is through a nasogastric tube.
 Do steps in preventing aspiration during feeding. Check the placing of the nasogastric
tube. Place patient in high Fowler’s position.
 Ensure patient’s comfort during suctioning and other procedure that involves
manipulating the endotracheal tube