Tracheal intubation, usually simply referred to as intubation, is the placement of a flexible plastic tube into the 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 of the lungs, including mechanical ventilation, and to prevent the possibility of asphyxiation or airway obstruction.




The most widely used route is orotracheal, in which an endotracheal tube is passed through the mouth and 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 invasive and extremely uncomfortable medical procedure, intubation is usually performed after administration of general anesthesia and a neuromuscular-blocking drug. It can however be performed in the awake patient with local or topical anesthesia, or in an emergency without any anesthesia at all. Intubation is normally facilitated by using a conventional laryngoscope, flexible fiberoptic bronchoscope or video laryngoscope to identify the glottis,
though other devices and techniques are available. 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 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 mechanical ventilator.
Once there is no longer a need for ventilatory assistance and/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 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 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
anesthesiology, critical care medicine, emergency medicine, gastroenterology, laryngology, pulmonology and surgery.


Tracheal intubation can be associated with minor complications such as broken teeth or lacerations of the tissues of the 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 pneumonitis, or unrecognized intubation of the esophagus which can lead to potentially fatal 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. The incidence of serious complications is unacceptably high
when undertaken by practitioners lacking adequate training and
experience.

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