Where does the tube go when intubated? A medical guide

September 23, 2025 •

3 min read

Intubation is a critical medical procedure, with the endotracheal tube carefully guided into the trachea, also known as the windpipe. This process secures an open airway for patients who cannot breathe adequately on their own, often under anesthesia or in emergency situations.

Quick Summary

The tube, known as an endotracheal tube, is inserted through the mouth or nose and guided past the vocal cords into the trachea, or windpipe, to ensure an open airway and enable mechanical ventilation.

Key Points

Tube Placement: The intubation tube is inserted through the mouth or nose and guided into the trachea (windpipe), located below the vocal cords.
Procedure Goal: Its main purpose is to maintain an open airway for a patient who cannot breathe on their own, often during surgery or a medical emergency.
Anatomical Path: The tube passes behind the tongue, past the epiglottis, and between the vocal cords to reach the trachea.
Final Position: The tip of the tube sits in the mid-trachea, above the point where the windpipe divides into the lungs.
Confirmation: Medical staff confirm correct placement using a stethoscope, waveform capnography, or a chest X-ray to ensure the tube is not in the esophagus or too far down.
No Talking or Eating: While intubated, a patient cannot talk because the tube passes through the vocal cords, nor can they eat or drink.
Cuff Inflation: A small balloon cuff on the tube is inflated to seal the airway, preventing leaks and protecting the lungs from fluids.

Understanding the Anatomy of Intubation

Understanding the pathway of the intubation tube requires familiarity with the respiratory system's anatomy. The procedure, commonly orotracheal intubation, involves carefully threading a tube through the mouth and into the trachea, ensuring it bypasses the esophagus.

The Path of the Endotracheal Tube

Insertion via the Mouth or Nose

The procedure typically begins with inserting a laryngoscope into the mouth. This instrument provides a clear view of the airway, often using a light or video camera, allowing the medical provider to maneuver the tongue and other tissues for a direct view of the vocal cords. While oral insertion is standard, nasal intubation is an alternative if the mouth is injured.

Passing the Vocal Cords

With the vocal cords in sight, the flexible plastic endotracheal tube is precisely advanced between them. This step is critical as the vocal cords mark the entry to the trachea.

Final Placement in the Trachea

The tube's ultimate destination is the trachea, or windpipe. It is positioned in the mid-trachea, ensuring the tip remains above the point where the trachea branches into the lungs. Proper placement is crucial; if the tube goes too deep, it can enter only one lung, leading to complications. After placement, a cuff at the tube's end is inflated to secure it and create a seal against aspiration. The tube is then fastened externally.

Confirming Correct Tube Placement

Confirming the tube's location is a vital safety measure involving multiple techniques:

Auscultation: Listening to the lungs and stomach with a stethoscope to check for proper breath sounds and rule out esophageal placement.
Waveform Capnography: Analyzing exhaled carbon dioxide levels and waveform, considered the most reliable confirmation method for tracheal placement.
Chest X-ray: Visual verification of the tube's position within the trachea, ensuring it's above the tracheal bifurcation.

The Purpose of Intubation

Intubation is performed for several critical reasons related to managing a patient's breathing and airway. These include providing respiratory support during general anesthesia, assisting patients in respiratory failure who cannot breathe effectively on their own, and protecting the airway from aspiration in unconscious patients.

Comparison of Intubation and Tracheostomy

Both procedures manage the airway but differ in method and duration.


Feature	Intubation (Endotracheal)	Tracheostomy
Insertion Method	Tube through mouth or nose into trachea.	Surgical opening into the trachea via the neck.
Duration	Typically temporary (days to a couple of weeks).	Used for longer-term ventilation needs.
Risks	Vocal cord injury, dental damage, esophageal intubation.	Infection, nerve damage, risk from surgical procedure.
Comfort	Can be uncomfortable, prevents speaking and eating.	Generally more comfortable for long-term use, may allow for speaking with special valve.

What to Expect During the Process

Before the Procedure

Prior to intubation, patients are typically given medication for relaxation or anesthesia. The medical team prepares by pre-oxygenating the patient.

During the Procedure

The intubation itself is a rapid process. The doctor uses the laryngoscope, inserts the tube, and confirms its correct positioning. The patient remains sedated throughout.

After the Procedure and Recovery

Post-intubation, patients are closely monitored while connected to a ventilator. The tube is removed (extubation) when the patient's condition improves and they can breathe independently. A sore throat or hoarseness is common afterwards.

Why is this Procedure Necessary?

Intubation is a critical intervention that can be life-saving by ensuring adequate oxygenation and protecting the airway when a patient is unable to do so themselves. It is a fundamental tool in modern medicine for respiratory support in various scenarios, from surgery to critical illness. For additional information on mechanical ventilation, resources like the National Heart, Lung, and Blood Institute provide valuable details.

Frequently Asked Questions

Intubation is the procedure of placing a tube into the windpipe to create a clear airway. A ventilator is the machine that the tube is connected to, which helps the patient breathe by delivering oxygen.

Doctors confirm correct placement using several methods, including listening to lung and stomach sounds with a stethoscope, using a carbon dioxide detector (capnography) that reads exhaled breath, and taking a chest X-ray.

The procedure is done while the patient is sedated or under anesthesia, so they do not feel pain during the process. A mild sore throat is common after the tube is removed.

After insertion, a small balloon-like cuff at the end of the tube is inflated to help keep it in place. The external portion of the tube is then secured with tape or a strap around the patient's head.

If the tube is mistakenly placed in the esophagus (food tube) instead of the trachea, it is a serious medical emergency. Medical professionals are trained to recognize and correct this immediately. If placed too far into one of the main bronchi, it can cause one lung to not receive air.

Intubation is necessary for many reasons, including providing respiratory support during surgery with general anesthesia, for patients with severe respiratory failure, or to protect the airway in an unconscious patient.

No, a patient cannot speak while intubated because the tube passes through the vocal cords, preventing them from vibrating to produce sound.

The duration of intubation varies. It can be for a short time during surgery or for a few days or weeks in intensive care. For long-term needs, a tracheostomy may be performed.