Intubation: Why It’s Done and How It Works

Intubation is a common, lifesaving medical procedure. This describes the process where a healthcare provider inserts a breathing tube into the trachea (windpipe). The insertion procedure is brief — lasting only a few minutes. But you can stay intubated (with a breathing tube in place) for days or weeks depending on your medical needs. While intubated, a ventilator (breathing machine) does the work of breathing for you. 

Successful and safe intubation requires a medical provider with expertise and specialized training. Anesthesiology, emergency department, and critical care providers have training in intubation. They’re most likely to intubate you in the hospital setting. Paramedics and transport teams also use the technique outside of the hospital. This is to safely care for or transport people who are critically ill.

When is intubation used?

Sometimes intubation is a planned procedure, as in the case of some surgeries. But many times intubation is an emergency procedure.  

Here are the most common reasons for intubation.

Abnormal breathing

Normal breathing involves two parts. You inhale to increase oxygen intake, and then you exhale to release carbon dioxide. When someone can’t breathe normally, it can cause low oxygen levels or high levels of carbon dioxide. 

Both are dangerous to major organs such as the heart, brain, and kidneys. Low levels of oxygen can cause healthy organs to stop working. High levels of carbon dioxide can cause neurological changes, coma, or death. 

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Common causes of severe breathing problems include:

• Infections, like pneumonia or sepsis

• Heart disease, like heart attack or heart failure

• Lung diseases, like asthma or COPD (chronic obstructive pulmonary disease)

• Unconsciousness, like brain injuries or metabolic problems

Trauma

Injury to any part of the airway (throat, vocal cords, or windpipe) can affect how you move air in and out of the lungs. The tube used in intubation provides a path for oxygen to reach the lungs and enter the bloodstream. It also allows you to exhale carbon dioxide.

Surgery

If surgery requires general anesthesia, you’ll be put to sleep and intubated for breathing support. Anesthesia medications used for sleep during surgery affect your ability to breathe. Intubation in the operating room allows the anesthesiologist to provide oxygen and medications.

How is intubation done?

Intubation happens once you’re unconscious or sedated with medication. That way you don’t feel or remember the procedure. Your provider will use a laryngoscope to perform the intubation. 

The provider places the laryngoscope in your mouth and repositions it so they can see the vocal cords. Then they pass a plastic tube through the vocal cords into the trachea. Once the tube is in place, they attach a ventilator to the tube. This machine does the breathing for you.

How long does intubation last?

The length of time someone stays intubated with a breathing tube depends on the reason for the intubation. It can range from the short amount of time it takes to complete a procedure to months while someone recovers from an injury or illness. 

People who need long-term intubation may need a tracheostomy. This is a more permanent breathing tube. It inserts into the front of the neck directly into the windpipe.

What are the risks of intubation?

Intubation is often used in life-threatening situations. So the benefits almost always outweigh the potential risks. But just like any medical procedure, complications can occur. 

Risks of intubation include:

• Improper placement: If the provider can’t see the vocal cords well, they may accidentally place the tube in the esophagus. If this happens, they need to repeat the procedure, and this may cause swelling or bleeding.

• Aspiration pneumonia: Vomiting during intubation can cause aspiration. This is where stomach contents get into the lungs. This is a lung irritant and can lead to more breathing problems and aspiration pneumonia.

• Trauma or bleeding: A laryngoscope can loosen, chip, or break a tooth. It also may cause bruising or bleeding to the mouth, tongue, or throat.

• Ventilator-associated pneumonia (VAP): Lung infections can develop when someone is on a ventilator. This is most common after several days of intubation.

• Blood pressure changes: Intubation may cause changes in blood pressure. Both high and low blood pressure can happen. Medication used to put someone to sleep during intubation can also lead to low blood pressure.  

Can you choose not to be intubated?

You should always feel empowered to express your wishes to your healthcare team during medical decisions. Some people may choose not to be intubated because of their overall health or beliefs.  

Intubations are often performed in emergency situations, and you may not be able to discuss the decision. So it’s important to clearly state your wishes in advance. Talking with family and friends is an important step in making your wishes known. 

There are also formal steps you can take. Do-not-resuscitate (DNR) and do-not-intubate (DNI) orders are legal documents about your healthcare. These will clearly state your wishes about intubation and other lifesaving procedures.

Are there any alternatives to intubation?

If you or your medical team decide against intubation, there may be other options. These alternatives may be helpful for a short time or as a bridge to intubation. But often they’re not enough to safely support breathing for a long time.

Alternatives to intubation can include:

• Oxygen: Simple oxygen tubing in the nose or on the face may increase oxygen levels. But this is limited and does not give any other breathing support.

• High-flow nasal cannula: Very high-flowing oxygen provides extra oxygen. It may also make the work of breathing easier.

• Noninvasive ventilation: Continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPap) are like a ventilator. But they’re not as powerful. A machine supports your own breaths through a mask on your face. This is not an option for those who are unconscious, vomiting, or have airway trauma.

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Written by:

Stephanie R. McGuire, MD, FASA

Stephanie R. McGuire, MD, is a freelance medical writer and pediatric anesthesiologist. She has more than a decade of experience in clinical pediatric anesthesiology, pediatric pain management, and medical education.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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