An endotracheal tube (ET tube) is a flexible plastic tube inserted through the mouth (or occasionally the nose) and passed through the larynx (voice box) into the trachea (windpipe). Once in place, an inflatable cuff creates a seal that protects the airway from aspiration of secretions or stomach contents, and the tube connects the patient to a mechanical ventilator or manual resuscitation bag.
Endotracheal intubation is performed to secure the airway and provide mechanical ventilation when a person cannot breathe independently or safely. It is a core procedure in the management of cardiac arrest: intubation provides a definitive airway for delivering ventilations and allows uninterrupted chest compressions to be given. After successful resuscitation, the ET tube is maintained in the intensive care unit while the patient is sedated and ventilated.
The procedure is performed by an anaesthetist, emergency physician, or intensivist using a laryngoscope to visualise the vocal cords and guide the tube into the correct position. Correct placement is confirmed by capnography (detecting carbon dioxide in exhaled breath), bilateral chest movement, and chest X-ray. Accidental placement of the tube in the oesophagus instead of the trachea is a serious and potentially fatal error, which is why confirmation is always required immediately after intubation.
Once intubated, patients require sedation and analgesia to tolerate the tube. Regular mouth care and position changes reduce the risk of ventilator-associated pneumonia. Removal of the tube (extubation) is planned once the patient can breathe independently and maintain a safe airway, assessed by a sedation hold and breathing trial.
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