What is Endotracheal Intubation: Procedure, Steps, Complications

Endotracheal Intubation is an emergency procedure of introducing ET or Endotracheal Tube Insertion. It is one of the widely performed medical procedures in a casualty to establish respiration in those who are unable to breathe.

Our guide below will help you with its indications, procedure, complications, and a video of course.

What is Endotracheal Tube Insertion?

Endotracheal Tube Insertion or Endotracheal Intubation (EI) is an emergency procedure most often performed in patients who are unconscious or who cannot breathe on their own. EI helps to prevent suffocation or obstruction of the passage of air.

In a typical EI, a patient is first given a heavy anesthetic. Then, a flexible plastic tube is placed into the trachea (windpipe) through the mouth or sometimes the nose to help the patient with breathing.

The trachea, also known as the windpipe, is a cylindrical tube that is about four inches long and one inch in diameter. It begins just under the voice box, descends behind the breastbone, and then divides into two smaller tubes. Each tube connects to one of your lungs.

The windpipe is made from discs of tough cartilage, muscle, and connective tissue. Its lining is composed of smooth tissue. Each time you breathe in, the windpipe gets slightly longer and wider—then returns to its normal size as you breathe out.


Basically, Endotracheal Tube Insertion is used for:

  • Provide airway for mechanical ventilatory support. Administration of surfactants or other medications directly into the lungs.
  • Relieve critical upper airway obstruction.
  • Provide a route for selective bronchial ventilation.
  • Assist in pulmonary hygiene when secretions cannot be otherwise cleared.
  • Obtain direct tracheal cultures.

Specifically, endotracheal tube insertion is used for the following conditions:

  • Respiratory arrest
  • Respiratory failure
  • Airway obstruction
  • Need for prolonged ventilatory support
  • Class III or IV hemorrhage with poor perfusion
  • Severe flail chest or pulmonary contusion
  • Multiple trauma, head injury, and abnormal mental status
  • Inhalation injury with erythema/edema of the vocal cords
  • Protection from aspiration


Endotracheal Intubation is an invasive procedure and can cause considerable discomfort. For this reason, general anesthesia and muscle-relaxing medication are usually administered so that you do not feel anything.

However, if necessary, the procedure can be performed while the patient is awake, with local anesthesia or with no anesthesia at all.

Procedure Steps

To begin the procedure steps, an anesthesiologist opens the patient’s mouth by separating the lips and pulling on the upper jaw with the index finger.

Holding a laryngoscope in the left hand, he or she inserts it into the mouth of the patient with the blade directed to the right tonsil. Once the right tonsil is reached, the laryngoscope is swept to the midline, keeping the tongue on the left to bring the epiglottis into view.

The laryngoscope blade is then advanced until it reaches the angle between the base of the tongue and the epiglottis. Next, the laryngoscope is lifted upwards towards the chest and away from the nose to bring the vocal cords into view.

Often during endotracheal intubation, an assistant has to press on the trachea to provide a direct view of the larynx. The anesthesiologist then takes the endotracheal tube, made of flexible plastic, in the right hand and starts inserting it through the mouth opening.

The tube is inserted through the cords to the point that the cuff rests just below the cords. Finally, the cuff is inflated to provide a minimal leak when the bag is squeezed.

Using a stethoscope, the anesthesiologist listens for breathing sounds to ensure the correct placement of the tube.


Waking Up While Under Anesthesia

According to the Mayo Clinic, about one or two people in every 1,000 wake up briefly while under the effects of general anesthesia. If this happens, usually you will be aware of your surroundings but will feel no pain.

On rare occasions of endotracheal intubation, people feel severe pain. This can lead to long-term psychological problems. Factors that may increase the risk of this happening include:

  • Emergency surgery
  • Heart or lung problems
  • Long-term use of opiates, tranquilizers, or cocaine
  • Daily alcohol use


There are some risks related to endotracheal intubation. To prevent these from occurring, you will be evaluated by the anesthesiologist (or ambulance personnel in an emergency situation) before the procedure and will be monitored throughout for potential complications such as:

  • Buildup of excess water in your tissues
  • Bleeding
  • Collapsed lung

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