Editing Tracheal intubation (section)

{{Short description|Placement of a tube into the trachea}}
{{Infobox medical intervention
| Name       = Tracheal intubation
| Image      = Glidescope 02.JPG
| alt        = Photograph of an anesthesiologist using the Glidescope video laryngoscope to intubate the trachea of an elderly person with challenging airway anatomy
| Caption    = [[Anesthesiologist]] using the Glidescope [[Laryngoscopy#Video laryngoscope|video laryngoscope]] to intubate the [[Vertebrate trachea|trachea]] of a [[Obesity-associated morbidity|morbidly obese]] elderly person with challenging [[airway]] anatomy
| ICD10      =
| ICD9       = {{ICD9proc|96.04}}
| OPS301     = {{OPS301|8-701}}
| MeshID     = D007442
| MedlinePlus = 003449
| OtherCodes =
}}

'''Tracheal intubation''', usually simply referred to as '''[[intubation]]''', is the placement of a flexible plastic [[catheter|tube]] into the [[vertebrate trachea|trachea]] (windpipe) to maintain an open [[airway]] or to serve as a conduit through which to administer certain drugs. It is frequently performed in critically injured, ill, or anesthetized patients to facilitate [[Ventilation (physiology)|ventilation]] of the lungs, including [[mechanical ventilation]], and to prevent the possibility of [[asphyxia]]tion or airway obstruction.

The most widely used route is orotracheal, in which an [[tracheal tube|endotracheal tube]] is passed through the mouth and [[larynx|vocal apparatus]] into the trachea. In a nasotracheal procedure, an endotracheal tube is passed through the nose and vocal apparatus into the trachea. Other methods of intubation involve surgery and include the [[cricothyrotomy]] (used almost exclusively in emergency circumstances) and the [[tracheotomy]], used primarily in situations where a prolonged need for airway support is anticipated.

Because it is an [[Invasiveness of surgical procedures|invasive]] and uncomfortable [[medical procedure]], intubation is usually performed after administration of [[General anaesthesia|general anesthesia]] and a [[neuromuscular-blocking drug]]. It can, however, be performed in the awake patient with [[local anesthesia|local]] or [[Topical anesthetic|topical anesthesia]] or in an emergency without any anesthesia at all. Intubation is normally facilitated by using a conventional [[laryngoscopy|laryngoscope]], [[fiberscope|flexible fiberoptic bronchoscope]], or [[Laryngoscopy#Video laryngoscope|video laryngoscope]] to identify the [[vocal cords]] and pass the tube between them into the [[trachea]] instead of into the esophagus. Other devices and techniques may be used alternatively.

After the trachea has been intubated, a balloon cuff is typically inflated just above the far end of the tube to help secure it in place, to prevent leakage of respiratory gases, and to protect the [[tracheobronchial tree]] from [[pulmonary aspiration|receiving undesirable material]] such as stomach acid. The tube is then secured to the face or neck and connected to a T-piece, anesthesia breathing circuit, [[bag valve mask]] device, or a [[Medical ventilator|mechanical ventilator]]. Once there is no longer a need for ventilatory assistance or protection of the airway, the tracheal tube is removed; this is referred to as extubation of the trachea (or decannulation, in the case of a surgical airway such as a cricothyrotomy or a tracheotomy).

For centuries, [[tracheotomy]] was considered the only reliable method for intubation of the trachea. However, because only a minority of patients survived the operation, physicians undertook tracheotomy only as a last resort, on patients who were nearly dead. It was not until the late 19th century, however, that advances in understanding of [[anatomy]] and [[physiology]], as well an appreciation of the [[germ theory of disease]], had improved the outcome of this operation to the point that it could be considered an acceptable treatment option. Also at that time, advances in [[endoscopy|endoscopic]] instrumentation had improved to such a degree that direct laryngoscopy had become a viable means to secure the airway by the non-surgical orotracheal route. By the mid-20th century, the tracheotomy as well as endoscopy and non-surgical tracheal intubation had evolved from rarely employed procedures to becoming essential components of the practices of [[anesthesia|anesthesiology]], [[Intensive-care medicine|critical care medicine]], [[emergency medicine]], and [[laryngology]].

Tracheal intubation can be associated with [[Complication (medicine)|complications]] such as broken teeth or lacerations of the [[Tissue (biology)|tissues]] of the [[Human pharynx|upper airway]]. It can also be associated with potentially fatal complications such as [[pulmonary aspiration]] of stomach contents which can result in a severe and sometimes fatal chemical [[Aspiration pneumonia|aspiration pneumonitis]], or unrecognized intubation of the [[esophagus]] which can lead to potentially fatal [[Hypoxia (medical)|anoxia]]. Because of this, the potential for difficulty or complications due to the presence of unusual airway anatomy or other uncontrolled variables is carefully evaluated before undertaking tracheal intubation. Alternative strategies for securing the airway must always be readily available.