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Some Problems with Endotracheal Intubation: A Guide to Help You Solve Them

Endotracheal intubation: a technique in which a specially designed tube is inserted through the mouth (oral endotracheal intubation) or nose (nasal endotracheal intubation) through the pharynx and larynx into the trachea.

Indications for endotracheal intubation

  • Patients with all kinds of congenital and acquired upper respiratory tract obstruction who need to establish a controllable artificial airway immediately;

  • Patients with various causes of lower respiratory tract secretion retention that require suction and drainage;

  • Patients who have cardiac and respiratory arrest due to various reasons and require artificial resuscitation and rescue;

  • Patients with respiratory failure due to various reasons who need artificial assisted ventilation;

  • Neonates with respiratory distress due to various reasons;

  • Tracheal anesthesia is required for surgical procedures.

The route and advantages of endotracheal intubation

Nasal endotracheal intubation


  • Nasal endotracheal intubation is more firmly fixed, with less sliding during nursing and artificial respiration;

  • Patients cannot bite the tube, and conscious patients feel more comfortable with nasal intubation and have better swallowing movement.

Oral endotracheal intubation


  • The operation is simple and convenient, and time-consuming;

  • It can avoid damage to the nasal cavity;

  • It is easy to suck sputum and change medicine.

Size selection of endotracheal intubation

Thinner tubes increase resistance to airflow. The airflow resistance of a 4mm endotracheal intubation tube is 16 times that of an 8mm endotracheal intubation tube. Therefore, the maximum diameter of the tracheal intubation should be selected for specific patients.

  • Typically male: 8.0mm-8.5mm;

  • Typically female: 7.5mm-8.0mm;

  • Nasal intubation is usually 7.0mm-7.5mm.

Insertion depth of endotracheal intubation

For adults, the depth is determined and estimated as follows: from the nostril to the auricle+3cm. From the incisors to the midpoint of the thyroid cartilage+3cm. Generally, adult males insert it 22cm orally and 25cm nasally, and adult females insert it 21cm orally and 24cm nasally. The black marked line at the front of the endotracheal intubation just enters the vocal cords.

For children, due to the large individual differences among children, one size larger and one size smaller tubes should also be prepared. Children under 5 years old generally do not use cuff tubes because the vocal cords under a child's glottis are funnel-shaped, and the tube is less likely to leak air after insertion.

After endotracheal intubation, pay attention to the "length mark" of the endotracheal intubation and use landmarks such as incisors or lips as a reference. This will help you monitor the position of the endotracheal intubation and check whether it is deviating outward or further downward into the bronchus. For specific patients, too long a endotracheal intubation may be more likely to kink and become blocked, and it may be necessary to cut it into a more suitable length.

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