Intubation
Formal Definition
Endotracheal intubation; the placement of a flexible tube (endotracheal tube, ETT) through the mouth or nose into the trachea to secure and protect the airway, provide mechanical ventilation, or administer anesthetic gases; confirmation of correct placement requires waveform capnography and is supported by bilateral breath sounds and CXR.
How It's Used on the Ward
"Intubated" or "tubing the patient" or "put on a vent" — placing a breathing tube; a patient who is intubated cannot speak and requires a ventilator.
Example
""Septic shock patient with GCS 8, respiratory rate 34, SpO2 83% on 15L NRB: decision made to intubate for respiratory failure and airway protection. RSI with ketamine and rocuronium. Blade to mouth: grade 1 view, ETT 7.5 passed through cords, cuff inflated, bag-mask ventilation: bilateral chest rise, waveform capnography confirms CO2. Vent connected.""
Clinical Context
Indications: respiratory failure (hypoxic or hypercapnic), airway protection (GCS <8, loss of gag reflex), anticipated clinical deterioration, procedural anesthesia. Confirm placement: waveform capnography (ETCO2) is the gold standard — esophageal intubation will show flat waveform. Bilateral breath sounds and misting of ETT are insufficient alone. Tube depth: typically 21-23cm at lip for adults (3 times the tube diameter + 2). Secure ETT: tape or commercial holder. Immediate complications: esophageal intubation (missed = catastrophic), right mainstem intubation (ETT too deep), hypotension post-induction, dental trauma. Post-intubation care: sedation and analgesia protocol, ventilator settings, HOB elevation 30-45 degrees (VAP prevention).
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