Endotrachial Intubation

November 6, 2012

It is a medical procedure in which a tube is placed into the trachea to open the airway, remove blockages and to provide oxygen, medication or anesthesia. It may be attached to a machine called a respirator that will breathe for the patient while the tube is still in place. Airway control and mechanical ventilation are often necessary in the treatment of severe burn injuries.

Swelling in the upper airway is a major concern in any person with a burn injury. Swelling may lead to acute respiratory insufficiency, in children the airway is smaller therefore they are more prone to develop airway obstruction from burn. Swelling and damage to the airway may be caused by inhalation of the gases and fumes caused by combustion and/or the effect of heat on the tissue (see smoke inhalation). The extent of the damage to the airways is not directly related to the severity of skin burns and in some cases it may become the greatest therapeutic problem in a gravely burned patient.

Although obstruction of the upper airways caused by edema (swelling of the tissue) may happen acutely, it may not be present until the edema is sufficient enough to produce clinical evidence of impaired airway patency which may take 12-18 hours. Therefore it is important to monitor the patient for any difficulty in respiration even though the patient may not have any problems initially.

Extensive face and neck burns increase the risk of airway compression and the need for early endotracheal intubation. Deep face burns may lead to airway obstruction due to intraoral edema which will in turn decrease the clearance of intraoral secretions and impair the protection of the airway from aspiration. Deep neck burns will increase the risk of airway compression and the need for early endotracheal intubation due to the external compression of the larynx by the swollen neck.

A decision will be made by the treating physician after initial assessment as to whether or not the airway can be managed safely without an endotracheal tube. The treating physician will also make the determination of how long the patient will be intubated and when the tube is taken out depending on the condition of the patient.

When the patient is intubated, he/she may stay in bed for a prolonged period of time, this may increase the risk of developing Deep venous thrombosis (see Deep venous thrombosis part I, II) which is the main cause of pulmonary embolism, these patients are given prophylactic measures to decrease the risk of deep venous thrombosis (medications and compression devices). Make sure that these devices are worn all the time and if they are disconnected (to walk or visit the restroom), make sure that they are reconnected when the patient returns to his/her bed.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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