The search term “Intubation” comes up fairly often on my blog’s traffic logs, so I thought I take a moment to write about it. Lord knows I’ve had my share of them.
I truly hope your asthma never gets to point where you actually need to be intubated and put on a ventilator, but here’s a brief explanation of the process and what goes on. I hope you find my explanation helpful in some way.
Intubation is a procedure in which a special tube called an “endotracheal tube” (ET tube for short) is inserted into your airway, so that you can be attached to an external and artificial breathing devise, such as a mechanical ventilator or an anesthesia machine. It also provides direct access to your lungs for medications, supplemental oxygen, etc.
Patients are intubated for a variety of reasons, the most common or routine being the need for general anesthesia during surgery. Other than that, people are intubated on an emergency basis when their lungs fail, or when their breathing or upper airway is compromised in some way. Though thankfully not very often, asthmatics are intubated when the lungs start to become so tight and obstructed, that the work of breathing becomes overwhelming. The person’s breathing can become so difficult that they start to tire out and could potentially stop breathing (what they call a respiratory arrest).
The procedure itself, involves placing an endotracheal tube, about the diameter of your middle finger and about 12 inches long, into your windpipe with the help of a tool (called a Laryngascope) that forces the tongue down and exposes the opening of your airway ( now you know why its nice to be asleep). Once inserted, the ET tube is held in place inside your airway by an inflatable balloon that’s built onto the bottom of the tube. The other end of the tube is secured to the corner of your mouth, either by tape or a special strap that goes around your head (you can see the ETT holder in the photo above). After the tube is inserted, the medical team will listen to your chest to make sure that air is actually going into your lungs and an xray is done to make sure the tube is in the correct position in the airway. ( Here’s a video showing an intubation on a mannequin to give you a visual idea)
Because complications can arise easily, the decision to intubate a tight asthmatic is never taken lightly, and is usually only done as a last resort, or when it appears that severe respiratory failure is imminent or present. During a really bad asthma attack the medical staff will keep a close eyes on you your vital signs, especially your breathing pattern and mental status. They’ll usually draw arterial blood gas (ABGs) samples to check for increases in CO2 and decreases in Ph and O2 , which can indicate impending respiratory failure. It’s been my experience though, that if you’re a really bad asthmatic with a history of prior intubations, that the doctors will just tell you right up front to alert them if you think you’re starting to poop out. This way they can intubate you before you go into full blown respiratory failure or loose consciousness and stop breathing all together.
So what does it actually feel like to be intubated?
Well, if everything goes the way it’s supposed to, you shouldn’t feel a thing because you’ll be asleep. In fact, you’ll probably welcome the temporary escape from the agonizing world of labored breathing. They usually put you to sleep with a combination of a powerful sedative and a paralytic agent that temporarily paralyses all of your skeletal muscles, making it easier to insert the tube into your sensitive airway. After you’re intubated they’ll put you on a ventilator, which is a type of life support machine that will breath for you allowing your lungs to rest. You’ll stay on the ventilator (hopefully asleep) anywhere from a few hours to a several days, depending on how sick or tight you are.
When it becomes evident that your respiratory status has improved, they will turn off the sedation and wake you up. At first you’ll probably be a little disoriented, but you’ll quickly regain your bearings. Because the breathing tube passes through your vocal cords, you wont be able to speak. You’ll have to communicate with hand gestures or by writing with a pen and paper. You’ll definitely be aware that there’s a foreign object in your throat, but it’s actually not painful. Probably the most uncomfortable part of having a breathing tube in your windpipe is when you have to be suctioned. Because it’s difficult to cough junk up through the tube, they literally have to suck it out with a special vacuum device called a suction catheter. As they insert the suction catheter down the breathing tube, the irritation will cause you to cough super hard, which can be a little uncomfortable , but you’ll catch your breath quickly. [ Here’s a clip taken a few years ago of me actually suctioning myself, just prior to being extubated. Don’t worry, you’ll never have to suction yourself. The only reason they let me do it is because ive been through this so many times, and because they knew I was a Respiratory Therapist by profession. ]
Now that you’re awake and hopefully doing a little better, it’s time to see if you’re ready to come off the vent. Once it’s been determined that you’re able to breath adequately on your own, they’ll begin the process of taking you off the ventilator. Because the ventilator has taken over most of the work of breathing during the time you were asleep, your breathing muscles will have probably weakened somewhat. For this reason, they have to wean or gradually withdraw you from the ventilator. Weaning a patient off a ventilator usually begins in the morning when there are lots of staff around to monitor you. They’ll usually do a few simple breathing tests, both on and off the ventilator to see if your strong enough to breath on your own. If you pass the tests and your lab work looks good, they’ll pull the tube out, a process they call “extubation”. If you’re too weak or still too tight, they’ll probably keep you on the ventilator and re- assess you a few hours later. They’ll continue this process until they’re confident that you will breath Ok without the help of the ventilator.
After the breathing tube is pulled out, they will usually place you on some supplemental oxygen, and if you’re still tight they might put you on Bipap and/or frequent neb treatments. You’ll probably also experience a sore throat and maybe a raspy voice, but these side effects are generally mild and often resolve within a few days. Hopefully, now that you’re extubated, you’ll continue to improve on your own and wont need to be re- intubated. Yes, sometimes patients do fine for awhile and then tire out again and have to be re-intubated. We’ll assume that wont happen to you, and in a few day you’ll be well enough to go home.
As person who’s been intubated an extraordinary number of times for asthma, I can tell you that the vast majority of those intubations went off without a hitch. I didn’t feel a thing during the procedure and recovered fully after coming off the ventilator. There were however, 2 occasions in which things didn’t go as planned. Both times had to do with problems relating to inadequate sedation. They intubated me, but for some reason the sedative portion of the drug combo never made it to my blood stream, either that, or my body didn’t respond to it. In any case, I remained totally awake, but completely paralyzed. There was no way I could tell anyone what was happening to me until the paralytic drug wore off. Anyway, it was a very traumatic experience for me, and one that still haunts me to this day. Odds are, this will never happen to you, but I think it’s important for people to know that when you’re dealing with any sort of anesthetic, that these kinds of things can happen.
Also, my experience of being intubated is just that… my experience. It’s a little different for everyone. For the sake of clarify in writing about the procedure , I probably sugar coated the actual experience just a touch. The truth is, it’s pure hell to go through an asthma flare that is so severe that it requires intubation and mech ventilation, but subtracting out the scariness of the situation ( if youve never been through it), I think paints of very accurate picture of what goes on.
So that’s the scoop on intubation as it relates to asthma. My advise is to stay on top of your asthma. Create an action plan with your doctor and take your medications as prescribed. Get a hold of your medical provider right away if you’ve been struggling with your asthma and not getting better. Be smart about your asthma and chances are you’ll never need to be hospitalized, let alone be intubated and placed on life support.
( Here’s a link to that bad experience I mentioned,) if you’re interested)