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 mechanical breathing device, such as a ventilator or an anesthesia machine. It also provides direct access to your lungs to deliver medications, supplemental oxygen, and to remove secretions.
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 the endotracheal tube, about the diameter of your middle finger and about 12 inches long, into your windpipe ( usually through your mouth) 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, including damage to the trachea and lungs, 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)
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I’m so afraid of this!!!!!!!!
Hopefully, you’ll never have to.
I went through an intubation… coma for 10 days and hospitalised for a month! Horrific – wouldn’t wish this on my worst enemy
It one of the most horrible things I’ve ever experienced
I am 20 years old and a new mother. Ive struggled with asthma for years and its just getting worse. I resently was intubated and in a coma for respiratory failor. Staph got into my system and attacked my lungs. The doctor clamed my lungs looked the worst she’d seen and they had to suction out my lungs of the infection. My poor mom didnt know if i was going to make it or not and my baby would of been left parentless as his dad isnt in the picture. I pray to god i get better and i dont have to go through that again.
I ran across this blog when looking for answers. Not only am i interested in what happened to me medicaly but im also trying to find out why my memory is so bad. Its spotty of the day i went in, i also didnt dream or anything. I cant recall anything for 5 days, just blackness and it didnt feel like 5 days but no more then a few hours. I then recall bits and peices of visitors as i started coming around and they say i was awake and trying to comunicate but i only recall maybe the first minute that they arived before my memory gos dark again. My memory is still spotty at home as i forget things alot and sometimes i feel like im going crazy.
I just hope i dont have to go through that again and im so sorry to hear that you have been intubated so many times. God bless you.
So sorry to hear that youve been struggling with your asthma . One of the dangers with asthma is that its very easy to contract pneumonia and other infections. Sometimes an infection can cause the asthma flare, and sometimes the asthma flare itself can make you more susceptible to infections from various bacteria and viruses. That’s because the drugs used to treat asthma (steroids) can weaken your immune system. The good news is that most of these infections can be treated and hopefully there wont be any temperament damage to your lungs. As far as memory problems, this is totally normal. Could be a combination of all sorts of things. Youve been through a lot and the stress itself can cause memory loss. Also the anesthetics used while you were intubated can cause short term memory loss. You’re probably still on prednisone, which can make you feel like your going crazy. Trust me, it may take a while, but your body will eventually heal and you will begin to feel better again. After that, do whatever you can to keep your asthma under control. There are lots of new treatment options emerging.
Take care Xx
I am 26 and just got off a vent of a vent for my asthma ! It was hands down the scariest thing I’ve ever been through. Our babies need us I hope You find peace and recovery. ?? Hopefully they can get it stabilized for you so you never have to go through that again. ??
Hello, I noticed that you posted this comment on 4-18-2021. Believe it or not, I was on a ventilator as well on that date. It was my 53rd time on a vent. I guess Im an old pro at it, but I know what you mean about scary. Hopefully you’re feeling better by now, though some of these exacerbation recoveries can last weeks. Thank you for sharing, take good care
Xx Steve
Thank you for your post. I keep learning more every day after having been intubated for the first and hopefully the last time. Wishing you all well.
Thank you
I came across your blog a few years ago when I first was admitted to the hospital for severe asthma. Your posts have been invaluable in helping me understand my disease better and handle recovery. I’ve been a lifelong asthmatic, but only in the past 5 years has it really escalated. I have a history of respiratory failure – I’m fine one minute and the next I’m struggling just to get the tiniest bit of air! The first time I had a wonderful doctor and I was immediately put on Bi-Pap, unfortunately I fought it so hard (I was apparently panicking, but I don’t remember much after telling the nurse something was wrong) I had to be sedated. I was in the ICU for about a week with pneumonia. I was lucky and recovered pretty quickly, but the experience was terrifying. I’ve never had to be intubated and honestly it’s one of my biggest fears as an asthmatic. I was recently in the hospital for yet another severe asthma attack and put, once again, onto the Bi-Pap machine. Only this time I did not get a good doctor – I got one very ignorant of asthma. She assumed because she could hear air in my upper airways and I was at 97% O2 I was fine. I couldn’t speak and my husband was literally begging them to help me. When I finally couldn’t keep up anymore they called a rapid response and the Respiratory Therapist and responding doctor couldn’t believe the ignorance of the ER doctor. My lower lungs hadn’t been able to expand due to an invasive staph infection and my lungs were filling with fluid. I was put into the PCU (it’s a step-down from ICU), and when I improved was taken off the Bi-Pap and moved to a regular room only to go into respiratory distress again and back down to the PCU on Bi-Pap once more. I was in the hospital for 10 days, my longest stay to date, but my recovery has been nonexistent. Almost three weeks after being discharged there has been absolutely no change. I’m still wheezing, but haven’t felt tight enough to warrant returning to the ER, and the fatigue is beyond severe. I feel just as weak as the day I left the hospital. I’d go back but I am terrified of having the same experience. My doctor has ordered more tests, but I’m wondering if you or any other asthmatics have experienced such a long and slow recovery. I haven’t been able to work for a month, and while my job is secure, my mental well being has been taking quite a hit. I’m very lucky to have a loving and understanding husband, but I feel like such a burden. This is my fourth hospitalization in as many years, I thought I knew what to expect, but as usual my asthma is keeping the upper hand. Well thanks for listening, sorry for the long comment and thank you for your blog. It really is lifeline sometimes.
Hi Sabrina, Im sorry to hear that you’re having such a hard time with your recovery. Unfortunately, a long, not so smooth recovery is pretty much the norm for a severe flare, especially if you have a secondary infection going on. While the larger airways typically respond quickly to the meds, the same isnt always true with smaller airways. Inflammation ( swelling) in those tiny airways can take much longer to reverse and can make you feel miserable in the process (Well that and the steroids) . It can take anywhere from a few weeks to a few months to feel like your old self again. Wish I had a magic formula to make you heal faster, but I dont. I dont know all the particulars of your illness, but after a really bad hospitalization I lay low for a couple of days and then I force myself into a normal routine as much as I can. Somehow this seems to work for me. Hang in there. Xx
Had an asthma attack due to fires wed night and kept in hospital til thurs evening. I get asthma attacks that land me in the er once every two years and I guess various things trigger it like certain smells or a bad cold. In between no other respiratory problems. I never care rescue inhaler and/or regular maintenance. Cause it’s so rare and hate to have these chemicals in me on a daily basis when an attack is so so rare .
This time it was different I was so tired of trying to breathe. How long does it take to go kaput? I had continuous neb, steroids , salbuterol, magnesium etc. I’m scared next time I will be intubated as each time it gets worse each time it seems.
Hi,
I have admitted in emergency on 6 th oct, 17 morning for my breathing or Asthma problem. They put me on nebulizer 4 times and tried other puffers for bringing my breathing to back to normal. After that they took me in some room where 5 to 6 ppl are working on me. After all this I woke up on 9 th oct,17 evening and than I came to know I m on ventilator. It was painful experience for me as I had asthma from last 10 years but never been through such kind of situation. Now, I am back home and still recovering. I still have pain in my shoulders and legs, also I can’t walk properly. How long normally it takes to be normal and I also having burry vision since than. Is that normal to have blurry vision after coming off from ventilator.
Hello, Sorry to hear about your hospitalization for asthma. It can take several days, sometimes a couple weeks to start feeling better after a bad asthma exacerbation. Being put on a ventilator can save your life, but it’s also very traumatic to the body. It’s common to have muscle pain after extubation, but blurry vision I have no experience with. Im assuming that you’re still on steroid pills , which unfortunately causes a lot of side effects as well. Good luck to you.
My brother 71 has always had asthma and older has alot of health problems. He is now in icu being kept asleep with the whole breathing tube and machine helping him breathe. They are saying that cant get the tube out that his muscles are tighten around the tube and they cant get it out they saying just going to try once every morning. You know anything about thus. Thank you. I’m so worried for him
Hi Stephen. My daughter is 9 and has had severe asthma since she was 3. She has been admitted to ICU every year – 2x a year – since. Well actually it was ICU 2x a year (Sept/Oct and then again in Jan/Feb every year most of the time) until 2015 then in 2016 she went into he hospital but not ICU and was only there 48 hrs both times! Which was AMAZING. This year (I count the year starting in in the fall) so far she has only had e.r. visits — we have gotten through both September and October with NO admittance — but she did have 2 severe and sudden asthma attacks that were very scary for us. We are not accustomed to her being fine 1 minute and then suddenly out of nowhere with no apparent trigger (though it could be environmental) her start struggling and her emergency inhaler does nothing to relieve the symptoms.
Both times they did 3 continuous back to back DUONEBS with strong steroid intravenously and she turned around REALLY quick like by the time the 3rd duoneb was done she would go from 02’s in the 80’s back up to near 100. and all her stats back to normal.
Last year we were put on the Red Advhair and using it properly as prescribed we started to see improvement — where she was still having lots of flare ups (up until last year her flare ups were progressive and her situation would get worse and worse and worse over a few days sometimes less — until she wasn’t making it between treatments until the treatments stopped working and she was struggling and is having 02’s drop into 80’s and the ambulance is being called and then admitted — and while thats not ideal excuse she seemed constantly sick from fall through winter — I atleast felt like I had some warning that it was coming on — I felt a little more in control — I could keep her home and make sure I was the one there if and when she hit rock bottom and needed the hospital and that everything was done properly because as you know time is of the essence with asthmatics. Now with these 2 sudden flare ups that seem to come out of nowhere I feel very out of control of her situation.) But they were not AS severe as the ones all the years before and even though she made it into the hospital as usual instead of a 10 day ICU stay (everytime the doc was ready to intubate but Annie being the fighter she is never tired out — even when her respiratory rate was 72/min at 6 years old) it was just a 2 day regular floor stay with a little supplemental 0s and iv steroids. So it was working! Well insurance stopped paying for the puffer that she uses with her spacer and started giving her the discus and she seemed to start having more flareups so her pulmonologist put her on symbicort puffer and she’s continued do amazing (outside outhouse two severe attacks) and thus far has not been in the hospital and has had almost no sick days – until yesterday that is. She woke up feeling like she needed a breathing treatment and then she needed one after that day and today she was jumping on the bed with her brother and she had to stop and use her inhaler. She seems fine otherwise — usually I can tell when she is starting to flare — but now I can’t — she is needing to use it and it is not apparent to me at all. It used to be I could look at her and tell her — “you’re feeling labored aren’t you”? And she would go take it — but now its like I can’t tell. So I don’t know what to do to try and make sure this doesn’t get out of control excuse I can’t tell where she is. Should I start her on a course of steroids (prednisolone) for 3 days since it seems like she may be having some sort of flare up (she stayed home form school yesterday so I could watch her and was otherwise totally normal nothing severe or concerning same today — the inhaler worked and she was just fine and she isn’t needing it at regular intervals.)
I see you have said many times — take your meds and control your asthma and you likely won’t ever end up in the hospital etc. Well we are doing that and yet she still had these 2 severe flare ups and now something else seems to be going on since yesterday — is this normal — is this common to happen even not he controller? Also her doctor gave us an oral pills he could start using but he said it could cause psychological effects and if it does to stop using it and within 10 days she should go back to normal. Well for that reason I decided to hold off unless this season seemed to be bad like the others but thus far it hadn’t seemed to be — but since those 2 attacks and now with what may be going on with her now I’m wondering if I should go ahead and take the chance and start her on it. Its called Montigukast or something I might have butchered the name.
Also — you say you have been intubated 38 times. Are you on a controller? What is causing you to not be bale to control your asthma? Is the medication just not working or are you not good with taking your preventative meds regularly? Im just trying to find out if its to be expected that despite all the medication and controllers that she could still end up in the hospital constantly.
I don’t have asthma but have been sick with bronchitis and a respiratory infection and went into and asthma/anxiety attack lasting all day after several nebulizer steroid shots and bypap I was put on a ventilator for 12 hrs. What a trip. Everything went smoothly for me and was just how you explained it.
How does it feel to be on ventilator??!? It sounds terrible. I have severe asthma.
Hi Susan, I’ve never been awake on a ventilator, I’ve always been knocked out, but to be honest, you don’t feel a thing. You’re asleep the entire time until the medical staff are trying to wean you off, you’re very groggy and weak. The only discomfort is the sore throat after they’ taken the tube out..I also have a tube that I think goes from up your nose to your stomach to retract any bile, ( I think ) but the absolute most scariest part for me was really not being able to breathe and begging for a tube, I don’t wish that upon anyone…and I absolutely hope you never have to experience it..I wish you all the best.
Fantastic blog, thank you so much for sharing. I’ve been intubated 5 times with asthma, it’s the most frightening thing not being able to breathe, and eventually begging to be tubed. I remember the first ever time I was intubated, I was 18, the doctor took my mum and dad to a room and told them I probably wouldn’t make it, my brother even went to the hospital chapel and prayed, and we’re not a religious family, but obviously someone or something was on my side that day, and 25 years and 4 more intubations on and I’ve only been back in hospital for asthma 3 times in the last 10 years, the last being April 2017, none of which I was intubated thankfully. I never really knew what went on when I was being knocked out, mum had try to explain, but this was such an insight to it all.. hopefully I’ll never be tubed again, and I certainly wish you all the very best, thank you so much
I went into cardiac and respiratory arrest two and a half years ago after a severe asthma attack and since then I’ve been suffering from PTSD from it. Has anyone else gone through this? I don’t know how to deal with it.
Hello and sorry to hear that. The same thing has happened to me twice. The first time was at age 16, so I barely remember it. But I had a resp arrest 2 years ago that left me with PTSD as well. I ended up seeing a shrink for a few months, which helped tremendously. If you have access, I highly recommend it.
Take care.
I’m thankful you shared this, and your other post about your experience. I was intubated for the first time this past wednesday. My experience wasn’t horrible but neither was it good (if you can call being intubated good). I went through a period where I thought I had died and gone to hell. Hell was nurses coming in and turning me, asking if I was in pain, telling me I was okay etc. but was across this void: just blackness. I would fall asleep and it would happen again, and in my mind it was only a couple of seconds. Just an overall weird feeling.
There were amusing moments. I managed to text my husband and those were funny. I also wrote home notes (it wasn’t always black) and I think I convinced him to buy me a DeTomaso Pantera. But that was probably just a dream. I had long drawn out conversations with people. Which I know now weren’t real
Thank you again for sharing your life as an asthmatic with us and giving us a chance to discuss our experiences. It has helped me for sure
Thank you so much for this detailed post and some of your comments and replies to questions. My daughters babysitter is 22 and is currently in the ICU hospital for severe asthma attack. We are all very sad and scared but don’t quite understand it because we don’t understand asthma as much. It seems like she was intubaited, and has been sleeping (medical coma?) for the last two days and addition to having pneumonia. We are getting updates from her family via text messages but we are just here a pile of nerves waiting for some news of improvement…
Sorry to hear that. It’s not uncommon to be on a ventilator ( usually in a medically induced coma) for several days. It’s also not uncommon to develop a pneumonia while on a ventilator, or have a pre-existing pneumonia that triggered the asthma flare in the first place, they often go hand in hand. Rest assured that she wont be aware of any of this while she’s asleep. As her condition improves they will wake her up and wean her off the ventilator.
Fingers crossed for you and your loved one.
Steve
When my son was younger he was diagnosed with moderate severe asthma. It was controlled with medication morning and night. He went to live with his dad in CO for a year and a half. After graduation he returned to TX to attend college and run track. After his 3rd week of track practice he is now in ICU due to a severe attack that came out of no where. His O2 states range between 87 and 91. All his test come back fine. They said he looks fine, test fine, even for most part acts fine but he isn’t. They can figure out what’s causing his levels to be so low and dependent on oxygen. I’m at my wits end and terrified. I too have asthma but not severe as well as I had heart surgery 8 years ago. I’m to the point of having MADE UP illusions of them doing CPR because he stopped breathing. I’m so terrified right now.
Sorry youre having to deal with that. It’s actually not uncommon for O2 sats to remain low for several days after a severe attack. It could be due to residual airway inflammation.
Try not to worry too much, it’s extremely rare for an asthmatic to stop breathing. Until he’s feeling better, the ICU is the best place for him. They can monitor him closely.