If a patient requires ventilatory assistance which cannot be adequately helped with mask ventilation (PAP devices), typically physicians will move immediately to invasive ventilation (endotracheal intubation). Due to the many well known side effects of invasive mechanical ventilation, all options should be exhausted to prevent the patient from requiring this level of support.

If intubation is initiated, all efforts should be placed on removal of the endotracheal (ET) tube as quickly, while as safely, as possible. Many complications from intubation can arise, including but not limited to:

  • Aspiration – Entry of material (such as secretions, food or drink, or stomach contents) from the mouth or other areas, into the airways. Consequences of pulmonary aspiration range from no injury at all, to pneumonia, to death within minutes from suffocation.
  • Esophageal intubation – While performing intubation, sometimes the placement of the tube can incorrectly occur into the esophagus (to the stomach). This, obviously, leads to many problems, and may include death in some situations.
  • Dental injury – Placement of the tube can sometimes cause damage to the teeth, soft tissue at the back of the throat, or vocal cords, when done incorrectly.
  • Pneumothorax – Placement of the tube too deep can result in only one lung being ventilated and can result in a pneumothorax (collection of free air in the chest cavity that causes the lung to collapse) as well as inadequate ventilation.
  • Much more

Before intubation, ensure that all other forms of ventilation have been attempted, including  Mask Ventilation or PAP, Biphasic Cuirass Ventilation (BCV), or Heated Highflow Nasal Cannula (HHNC). All of these means of support are non-invasive means of cardiopulmonary support, which has successfully been used to avoid intubation, or remove endotracheal tube.

If determined that a patient will require ventilatory support long term while intubated, a trach may be considered, but all options to prevent the patient needing the tracheostomy have not been exhausted until ventilator weaning is attempted using these alternative modalities these alternative modalities  to assist the weaning process and as a means to meet the patient’s ongoing needs for support non-invasively either individually or in combination, whichever most benefits the patient toward preventing the trach from coming into consideration. This approach offers a greatest likelihood that the ET tube can be successfully removed and a trach procedure prevented.