Intubation involves placing a flexible plastic tube through the mouth (or sometimes the nose) and into the windpipe so a machine can breathe for you. From the outside, it looks like a clear or semi-clear tube about the width of a finger extending from the corner of the mouth, held in place with tape or a plastic strap, and connected to a ventilator by corrugated tubing. The entire procedure typically takes under two minutes once medications are given, but understanding what happens before, during, and after can make it far less alarming if you or someone you care about goes through it.
What Happens Right Before
The process starts with an IV line in the arm. Through that line, a medical team delivers a sedative to put you to sleep and a paralytic medication to relax the muscles of the jaw and throat. These medications take effect within about 45 to 60 seconds. During that brief window, the team places an oxygen mask over your nose and mouth to flood your lungs with extra oxygen, building a reserve so your body stays well-oxygenated while the tube is placed.
You are fully unconscious before any instruments go near your airway. You won’t feel, see, or remember the tube being placed.
The Procedure Step by Step
Once you’re sedated, the provider tilts your head back to straighten the path from your mouth to your windpipe. They insert a laryngoscope, a handled instrument with a light and a smooth, dull blade, into your mouth. The blade pushes the tongue out of the way and lifts a small flap of tissue called the epiglottis, which normally covers the entrance to the airway when you swallow.
With the epiglottis lifted, the provider can see the vocal cords and the opening of the windpipe. In an ideal view, most of that opening is clearly visible. Sometimes only part of it can be seen, which makes placement trickier but is still manageable. Some hospitals use a video laryngoscope with a tiny camera at the blade tip that projects the view onto a bedside screen, giving the team a magnified picture without needing a perfectly straight line of sight.
The provider then slides the endotracheal tube, a flexible plastic tube roughly 7 to 8 millimeters across for an adult, through the vocal cords and into the windpipe. A small balloon (called a cuff) near the tip of the tube is inflated with air to seal the tube against the walls of the windpipe. This seal keeps air from leaking and prevents fluids from dripping into the lungs. The laryngoscope is then removed, and the tube stays in place.
What It Looks Like From the Bedside
If you’re visiting someone who has been intubated, here’s what you’ll see. A tube, usually clear or light blue, exits from the corner of their mouth. It’s secured with adhesive tape across both cheeks or with a molded plastic holder that wraps around the head. The tube connects to a wider piece of corrugated tubing that leads to the ventilator, a machine on a rolling stand next to the bed. The ventilator’s screen displays numbers and waveforms showing each breath.
The person’s mouth will be slightly open around the tube, and their lips may look dry. A small pilot balloon, about the size of an olive, hangs from a thin line attached to the tube near the mouth. This lets the medical team check that the sealing cuff inside the windpipe is properly inflated. You may also notice a thin tube running from the mouth or nose into the stomach, used to drain fluid or deliver nutrition. Monitors attached to the chest, finger, and arm track heart rate, oxygen levels, and blood pressure continuously.
Because sedation keeps the person still and comfortable, they’ll appear to be in a deep sleep. Their chest will rise and fall rhythmically with each machine-delivered breath. Some patients have their wrists gently restrained as a precaution so they don’t reach for the tube if they become partially aware.
How the Team Confirms Correct Placement
Getting the tube into the windpipe rather than the esophagus (the tube leading to the stomach) is critical. The team verifies placement in several ways, starting immediately. They squeeze air through a bag attached to the tube and listen with a stethoscope over both sides of the chest and over the stomach. Breath sounds on both sides and silence over the stomach confirm the tube is in the airway.
The most reliable check is a device that measures carbon dioxide in exhaled breath. Because the lungs release carbon dioxide with every breath, a steady waveform of CO2 on the monitor confirms the tube is in the right place. In cardiac arrest patients, even a CO2 reading above 5 mmHg by the seventh breath is considered a reliable sign of correct positioning. A chest X-ray is usually taken shortly after to verify the tube’s depth and make sure it sits in the center of the windpipe rather than too far down into one lung.
What the Ventilator Does Afterward
Once the tube is confirmed in position, the ventilator takes over breathing. It delivers a set number of breaths per minute, typically around 12 for most adults, and pushes a measured volume of air with each breath, usually 400 to 500 milliliters to start. The oxygen concentration begins at 100 percent and is quickly lowered to safer levels as the team monitors blood oxygen readings.
The machine also applies a small amount of constant pressure to keep the tiny air sacs in the lungs from collapsing between breaths. Every setting is adjustable, and respiratory therapists fine-tune them based on blood oxygen levels, CO2 readings, and the patient’s underlying condition. Alarms on the ventilator sound if pressure changes suddenly, if the tube shifts, or if the patient starts breathing against the machine’s rhythm.
What the Person Experiences
During the placement itself, the person feels nothing because of the sedation. While intubated, patients are kept on a continuous drip of sedatives and sometimes pain medication. The level of sedation varies. Some patients are kept deeply asleep, while others are kept lightly sedated so they can respond to simple commands like squeezing a hand.
Because the tube passes between the vocal cords, talking is impossible while it’s in place. Patients who are awake enough to communicate can mouth words, nod, or write on a small whiteboard. After the tube is removed (a process called extubation), a sore throat and hoarse voice are common and typically last a day or two. Some people remember fragments of their time on the ventilator, while others recall nothing at all.
Nasal Intubation
In some situations, the tube is placed through a nostril instead of the mouth. The tube follows the nasal passage, curves down the back of the throat, and enters the windpipe the same way. From the outside, it looks like a tube taped to the nose rather than emerging from the mouth. Nasal intubation is less common but may be chosen for certain jaw or mouth surgeries where the oral route would interfere with the procedure.