What Is an Endotracheal Tube?

An endotracheal tube is a flexible tube that is placed in the trachea (windpipe) through the mouth or nose. It can be used to assist with breathing during surgery or to support breathing in people with lung disease, chest trauma, or airway obstruction.

Medications and numbing sprays can help reduce discomfort and make the placement of the tube easier. However, endotracheal tubes can cause side effects like vocal hoarseness and sore throat. When used for a prolonged time, severe complications like pneumonia and collapsed lung may occur.

This article explains when endotracheal tubes are needed, how they are placed, and the possible risks and complications.

Why Are Endotracheal Tubes Used?

An endotracheal tube is often used during surgery and in emergency situations. It is typically placed when a person is unable to breathe on their own. The placement of the tube is called endotracheal intubation.

There are many reasons why endotracheal intubation is used, including:

• Surgery: When a person is under general anesthesia, the lungs are paralyzed. Intubation allows the tube to be connected to a mechanical ventilator to assist with breathing.
• Breathing support: An endotracheal tube can support breathing in people with severe pneumonia, a head injury, collapsed lung, respiratory failure, congestive heart failure, acute respiratory distress syndrome (ARDS), or other conditions that affect breathing.
• Foreign object obstruction: Endotracheal intubation can help remove a foreign object lodged in the airway.
• Airway protection: An endotracheal tube can prevent the contents of the stomach from getting into the lungs during a massive gastrointestinal bleed.
  

Endotracheal Tube Types and Sizes

Endotracheal tubes are flexible tubes made from different materials, such as polyvinyl chloride (PVC), rubber, or silicone.

An endotracheal tube may have one or two channels, known as lumens. A double-lumen endotracheal tube is often used when it is necessary to ventilate each lung separately, such with certain lung or chest surgeries.

Endotracheal tubes come in different sizes ranging from 2.0 to 10.5 millimeters (mm) in diameter. The bigger tubes are used for larger adults and the smallest ones are used for premature babies.

At the end of most endotracheal tubes is an inflatable balloon called a balloon cuff. The cuff is inflated to keep the tube securely in place in the mouth after intubation.

How to Prepare for an Endotracheal Tube

If you're having a planned procedure where endotracheal intubation will be used, there are things you can do to prepare:

• If you are undergoing general anesthesia, quitting smokinga day or two beforehand can lower your risk of complications.
• Stop eating or drinking at least six hours before surgery to reduce the risk of vomiting and aspiration (breathing foreign substances into your lungs).
• Proper oral hygiene, such as an antiseptic mouth rinse and tooth brushing, can reduce the risk of infection following endotracheal intubation. Do not over-brush, as this can cause bleeding.
• Remove any mouth or face jewelry, as well as dental appliances, the morning of your procedure. This includes nose rings, mouth rings, tongue piercings, dentures, retainers, etc.
  

How Endotracheal Intubation Is Done

An endotracheal tube is usually placed when a person is unconscious. If it is done while a person is conscious, medications can be used to help ease anxiety and prevent nausea.

Before Intubation

Before an endotracheal tube is placed:

• Oxygen may be given to increase blood saturation levels. This ensures there is enough oxygen should the placement take longer than expected.
  
• Once the person is unconscious, an oral device may be inserted in the mouth to keep the tongue out of the way so the tube can be placed more easily.
• If a procedure is done while a person is awake, an antiemetic drug may be given to prevent nausea and vomiting. An oral anesthetic can help numb the gag reflex.

Intubation

During endotracheal intubation, the practitioner usually stands at the head of the table looking toward the person's feet. Pillows or padding may be placed under the person's head or neck to make airway access easier.

To perform endotracheal intubation:

1. A lighted scope is inserted into the mouth to view the back of the throat.
2. While holding the jaw open, the practitioner will thread the tube into the throat past the larynx (voice box) and into the lower trachea.
3. The practitioner will check that the tube is properly placed by first listening to lung and abdominal sounds. A mobile chest X-ray can help confirm the placement along with a device called an end-tidal CO2 detector that measures carbon dioxide expelled from the lungs.
4. The balloon cuff is inflated to keep the tube from moving out of place.
5. The external part of the tube is taped to the person's face to avoid slipping.
   

After the tube is connected to the mechanical ventilator, respiratory vital signs are continuously monitored. Secretions may be suctioned occasionally to keep the tube clear.

Endotracheal Tube Removal

Before removing the tube ( extubation ) and disconnecting it from the ventilator, the healthcare provider will assess whether the person is able to breathe on their own.

To be safe, people are generally weaned off ventilation slowly and continually monitored to ensure that everything is OK. Nurses will check their respiratory rate, level of consciousness, oxygen saturation levels (as measured by a pulse oximeter), and arterial blood gasses (ABGs).

If indications are good, the tape holding the tube on the face is removed. The balloon cuff is then deflated, and the tube is firmly and steadily pulled out. The removal may feel odd, but it is usually not painful.

Side Effects and Risks of Endotracheal Tubes

A sore throat is common following endotracheal intubation. It usually lasts a few days.

Around one-third to half of people who have been intubated experience vocal hoarseness for up to a week. Less than 1% have hoarseness for longer than a week.

Possible Complications

Complications of endotracheal intubation tend to affect people who had emergency intubation, have a pre-existing lung condition, or have been intubated for more than seven days.

• Tracheal bleeding
• Dental injuries
• Oral infections or mouth sores
• Sinusitis (sinus infection)
• Vocal cord injury, sometimes permanent
• Pneumonia, including aspiration pneumonia
• Tracheal stenosis (narrowing of the trachea)
• Tracheomalacia (collapse of the trachea due to cartilage thinning)
• Tracheoesophageal fistula (an abnormal opening between the trachea and esophagus)
• Pneumothorax (a collapsed lung)

Prolonged Intubation

If endotracheal intubation is scheduled, it is usually removed soon after the procedure is completed. Other people may need intubation and mechanical ventilation longer due to a severe or critical illness.

Even so, the tube cannot be left indefinitely and should be removed within 14 days. Leaving it in any longer can cause the thinning of cartilage and the narrowing of the airway passage.

If a person is unable to breathe on their own after 14 days, they may need to undergo a tracheostomy . This is done by making an incision in the neck and passing a tube into the trachea through the hole.

While an endotracheal tube is in, a person cannot speak or eat. To ensure nutrition, a nasogastric (NG) tube may be threaded into the nostril and into the stomach to deliver liquid food. Intravenous feeding through a vein (total parenteral nutrition) may also be used.

Others with serious medical conditions may need a feeding tube placed through a hole in their abdomen. These include a percutaneous endoscopic gastrostomy (PEG) tube, which delivers food to the stomach, and a jejunostomy tube (J-tube), which delivers food to the small intestine.

Summary

There are many uses for endotracheal intubation. Endotracheal tubes support breathing during surgery or for those unable to breathe on their own for any number of reasons. It can also be used to remove foreign objects from the airways or to protect the airways if there is severe gastrointestinal bleeding.

Common side effects like hoarseness or sore throat typically clear within a few days. The risk of serious complications like pneumonia increases if intubation is needed for more than seven days.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Lynne Eldridge, MD
Lynne Eldrige, MD, is a lung cancer physician, patient advocate, and award-winning author of "Avoiding Cancer One Day at a Time."

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