Indications for intubation

Introduction to Indications for Intubation

• Definition: Intubation refers to the placement of a tube into the trachea to facilitate mechanical ventilation.
• Objective: To maintain adequate oxygenation and ventilation, protect the airway, and manage intracranial pressure.

Indications for Intubation

• Respiratory Failure
• Cardiovascular Instability
• Airway Protection
• Severe Metabolic Acidosis
• Reduced Consciousness
• Facilitation of Surgery or Procedure
• Transport

Respiratory Failure

• Acute Hypoxaemia: PaO2 < 60 mmHg or SaO2 < 90% despite oxygen therapy
• Hypercapnia: PaCO2 > 45 mmHg with acidosis (pH < 7.35)
• Respiratory Distress: Use of accessory muscles, severe tachypnoea

Cardiovascular Instability

• Severe Hypotension
• Cardiac Arrest
• Shock States

Airway Protection

• Severe facial trauma
• Upper airway obstruction
• Risk of aspiration
• Low GCS (see below)

Severe Metabolic Acidosis

• pH < 7.2
• Refractory to medical management

Reduced Consciousness

• Glasgow Coma Scale < 8
• Drug overdose
• Other encephalopathic states

Facilitation of Surgery or Procedure

• General anaesthesia
• Certain diagnostic procedures requiring airway control

Transport

• Inter-hospital transfer requiring mechanical ventilation

Contraindications

• Direct contraindications are rare but may include:
  • Untreated pneumothorax
  • Unstable cervical spine fracture