Editing Tracheal intubation (section)

==Indications==
Tracheal intubation is [[indication (medicine)|indicated]] in a variety of situations when illness or a medical procedure prevents a person from maintaining a clear airway, breathing, and [[Oxygenation (medical)|oxygenating]] the blood. In these circumstances, [[Oxygen therapy|oxygen supplementation]] using a [[simple face mask]] is inadequate.

===Depressed level of consciousness===
Perhaps the most common indication for tracheal intubation is for the placement of a conduit through which [[nitrous oxide]] or [[volatile anaesthetic|volatile anesthetics]] may be administered. [[General anaesthetic|General anesthetic agents]], [[opioid]]s, and neuromuscular-blocking drugs may [[hypoventilation|diminish]] or even [[apnea|abolish]] the [[Control of respiration|respiratory drive]]. Although it is not the only means to maintain a patent airway during general anesthesia, intubation of the trachea provides the most reliable means of oxygenation and [[Ventilation (physiology)|ventilation]]<ref name=Ezri2007/> and the greatest degree of protection against regurgitation and pulmonary aspiration.<ref name=AHA2005-III/>

Damage to the brain (such as from a massive [[stroke]], [[non-penetrating head injury]], [[Substance intoxication|intoxication]] or [[poison]]ing) may result in a [[Altered level of consciousness|depressed level of consciousness]]. When this becomes severe to the point of [[stupor]] or [[coma]] (defined as a score on the [[Glasgow Coma Scale]] of less than 8),<ref name=ATLS2004CH6/> dynamic collapse of the extrinsic [[Larynx#Extrinsic muscles associated with the larynx|muscles of the airway]] can obstruct the airway, impeding the free flow of air into the lungs. Furthermore, protective airway reflexes such as [[cough]]ing and [[swallowing]] may be diminished or absent. Tracheal intubation is often required to restore patency (the relative absence of blockage) of the airway and protect the tracheobronchial tree from pulmonary aspiration of gastric contents.<ref name=Kabrhel2007/>

===Hypoxemia===
Intubation may be necessary for a patient with [[hypoxemia|decreased oxygen content]] and [[oxygen saturation]] of the blood caused when their breathing is inadequate ([[hypoventilation]]), suspended ([[apnea]]), or when the lungs are unable to sufficiently [[diffusion capacity|transfer gasses to the blood]].<ref>{{cite web |last1=Mallinson |first1=Tom |last2=Worrall |first2=Mark |last3=Price |first3=Richard |last4=Duff |first4=Lorna |date=2022 |title=Prehospital endotracheal intubation in cardiac arrest by BASICS Scotland clinicians |url=https://rgdoi.net/10.13140/RG.2.2.24988.56969 |language=en |doi=10.13140/RG.2.2.24988.56969}}</ref> Such patients, who may be awake and alert, are typically critically ill with a multisystem disease or [[Polytrauma|multiple severe injuries]].<ref name=Ezri2007/> Examples of such conditions include [[Spinal cord injury|cervical spine injury]], [[flail chest|multiple rib fractures]], severe [[pneumonia]], [[acute respiratory distress syndrome]] (ARDS), or near-[[drowning]]. Specifically, intubation is considered if the [[arterial blood gas|arterial]] [[partial pressure]] of oxygen (PaO<sub>2</sub>) is less than 60&nbsp;[[Torr|millimeters of mercury]] (mm Hg) while breathing an inspired O<sub>2</sub> concentration ([[FiO2|FIO<sub>2</sub>]]) of 50% or greater. In patients with [[Hypercapnia|elevated arterial carbon dioxide]], an arterial partial pressure of CO<sub>2</sub> (PaCO<sub>2</sub>) greater than 45&nbsp;mm Hg in the setting of [[Acidosis|acidemia]] would prompt intubation, especially if a series of measurements demonstrate a worsening [[respiratory acidosis]]. Regardless of the laboratory values, these guidelines are always interpreted in the clinical context.<ref name=Holcroft2010/>

===Airway obstruction===
Actual or impending airway obstruction is a common indication for intubation of the trachea. Life-threatening airway obstruction may occur when a [[foreign body]] becomes lodged in the airway; this is especially common in infants and toddlers. Severe [[blunt trauma|blunt]] or [[penetrating trauma|penetrating]] injury to the face or neck may be accompanied by [[edema|swelling]] and an expanding [[hematoma]], or injury to the [[Tracheobronchial injury|larynx, trachea or bronchi]]. Airway obstruction is also common in people who have suffered [[smoke inhalation]] or burns within or near the airway or [[epiglottitis]]. Sustained [[Tonic–clonic seizure|generalized seizure activity]] and [[angioedema]] are other common causes of life-threatening airway obstruction which may require tracheal intubation to secure the airway.<ref name=Ezri2007/>

===Manipulation of the airway===
Diagnostic or therapeutic manipulation of the airway (such as bronchoscopy, [[Laser medicine|laser therapy]] or [[stent]]ing of the [[Bronchus|bronchi]]) may intermittently interfere with the ability to breathe; intubation may be necessary in such situations.<ref name=Kabrhel2007/>

=== Newborns ===
Syndromes such as [[Infant respiratory distress syndrome|respiratory distress syndrome]], [[Congenital Heart Disease|congenital heart disease]], [[pneumothorax]], and [[Shock (circulatory)|shock]] may lead to breathing problems in newborn infants that require endotracheal intubation and mechanically assisted breathing ([[mechanical ventilation]]).<ref name=":0">{{Cite journal|last1=Bruschettini|first1=Matteo|last2=Zappettini|first2=Simona|last3=Moja|first3=Lorenzo|last4=Calevo|first4=Maria Grazia|date=2016-03-07|title=Frequency of endotracheal suctioning for the prevention of respiratory morbidity in ventilated newborns|url=|journal=The Cochrane Database of Systematic Reviews|volume=3|issue=5 |pages=CD011493|doi=10.1002/14651858.CD011493.pub2|issn=1469-493X|pmid=26945780|pmc=8915721 |hdl=2434/442812|hdl-access=free}}</ref> Newborn infants may also require endotracheal intubation during surgery while under [[general anaesthesia]].<ref name=":0" />