Endotracheal intubation involves placing a plastic tube into the trachea to maintain an open airway. It is used to administer oxygen, remove secretions, ventilate the lungs, and treat respiratory failure. Indications include respiratory muscle fatigue, respiratory failure, neurological issues, chest injuries, and airway obstruction. The procedure requires proper positioning, use of a laryngoscope to visualize the vocal cords, and passing the tube through the cords into the trachea while visualizing placement. Correct tube placement must be confirmed before securing and connecting to a ventilator. Complications can include tube misplacement, injury, infection, or lung damage.

1. Endotracheal intubation
Prepared by Dr Wahdat Alkozai

2. DEFINITION
Endotracheal intubation is
the placement of a flexible
plastic tube into the
trachea to maintain an
open airway or to serve as
a conduit through which to
administer certain drugs.

3. PURPOSE
 To administer oxygen
 To remove secretions
 To ventilate the lungs.
 To establish and maintain airway
 To treat acute respiratory failure and
persistent hypoxemia.

4. INDICATIONS
 Excessive use of respiratory muscle muscles leading to
fatigue
 Respiratory failure
 CNS Depression.
 Neuromuscular disease.
 Chest wall injury.
 Upper airway obstruction.
 Aspiration prophylaxis.
 Fracture vertebrae and spinal cord.

5. ARTICLES REQUIRED
 Sand Bag /Towel roll
 Suction apparatus with Tubing
 Suction Catheter
 Ambu bag and Mask
 Oxygen source and Tubing
 Laryngoscope with appropriate size blade
 Magill’s Force

6. Cont…..
 Endo tracheal tube of appropriate size
 Stylets
 Xylocaine jelly
 Plastic syringe 10ml
 Oral airway
 Cotton Tape
 Gloves
 Face mask

7. Endotracheal tube

9. MAGILL’S FORCEPS

10. SUCTION APPARATUS

11. Tube size
 Inner diameter in mm
 Depth of insertion
4
DI=Inner diameter ×3

12. Technique of Intubation
 Raise the head by 5 cm with a block or towel roll

13. POSITION FOR INTUBATION
 Position your patient
in supine position
with head extended
by keeping sand bag
or towel role under
the neck.

14. PROCEDURE
 Hold the laryngoscope with LEFT hand irrespective of
dominant hand
 Open the mouth with right hand index finger with
support of thumb.
 Introduce Laryngoscope from right angle of mouth
 Shift the tongue to left and go in.
 Press over tongue.
 See epiglottis and lift it.
 Watch for vocal cord

15. Procedure cont..

16. Procedure cont..

17. Procedure cont..
 Take the tube in right hand
 Introduce under vision
 Confirm placement by auscultation
 If tube is cuffed inflate the cuff
 Connect the source to tube
 Confirm the position of tube
a) by auscultation
b) by chest expansion
c) by bag movement
 Fix the tube with adhesive.

18. Stabilizing ET Tube

19.  Connection to ventilate
with
-ambu's bag
-anesthesia machine
-ventilator

20. ENDO TRACHEAL TUBE IN PLACE

21. POST PROCEDURE CARE
 Place the patient in lateral position
 Arrange for chest X-ray in order to check placement of ET Tube
 Apply endotracheal suctioning as needed.
 Watch for chest movements, ET Tube kinking, obstruction,
leakage of tube cuff and over inflation of cuff

22. Position of ETT
 Auscultation of breath sounds in both axillae
 Absence of breath sounds over the stomach area
 Symmetrical chest expansion with positive pressure breaths
 Improvement in color, heart rate and perfusion
 Improvement in oxygenation as measured by pulse oximeter
 After stabilization the precise location of ET tube may be
checked by radiography

23. Advantage of endotracheal intubation
 Provide a secure and stable airway for oxygenation and
ventilation
 Protect the airway against gross aspiration
 Allow removal of secretions
 Reduce dead space
 help avoid gastric distention
 Provide route for drug delivery
 Allow hyperventilation in patient with raised ICP

24. When endotracheal intubation is ineffective ???
 ETT is to small
 Inadequate size or poor compression of the resuscitation
bag is giving inadequate tidal volume
 Poor compliance of lung or airway obstruction may
require higher pressure to be applied
 ET tube is blocked
 Lungs are being compressed from out side

25. Cont….
When a patient with ETT shows sudden deterioration one
of the following condition should be looked for which can
be remembered by the acronym DOPE
 D- displacement
 O- obstruction
 P- pneumothorax
 E- equipment failure

26. COMPLICATIONS
 Tube in esophagus
 Endo bronchial Intubation
 Trauma to lips and tooth
 Laryngeal and tracheal Injury
 Barotrauma to lungs
 Bleeding
 Tracheities
 Pulmonary infection and sepsis