Intubation is the medical procedure to maintain an airway and access to the lungs. Intubation generally involves a patient who is unconscious or anesthetized beforehand, in order to place a tube down the patient's throat. Intubation is generally used in emergency medical situations or surgical procedures where the patient is under general anesthesia.
Intubation is a common procedure but it carries a number of risks. Some injuries can be caused by lacerations, aspiration, or infections. However, the most serious risks may involve failure to intubate, delayed intubation, or a misplaced breathing tube, where the patient can suffer brain damage if they do not receive enough oxygen to the brain. When an intubation accident is caused by medical error, the injury victim may have a claim for medical malpractice.
Intubation Procedure During Pregnancy and Labor
Endotracheal intubation (EI) provides oxygen and ventilation for individuals who are unconscious or unable to breathe on their own. Intubation is an invasive procedure and generally requires the individual to be unconscious or under anesthesia because the natural gag reflexes would prevent a tube from being inserted down the throat.
The endotracheal tube is inserted into the trachea using a laryngoscope. The laryngoscope keeps the tongue and epiglottis depressed to give the user a clear view of where the intubation tube needs to be inserted. Providing oxygen to the lungs (and taking carbon dioxide from the lungs) can be done manually with a bag valve mask device or using a mechanical ventilator.
Intubation is not common for pregnancy and labor. However, there are situations where intubation is required for the safety of the mother and/or child. Generally, intubation may be required if:
- The mother has a difficult airway that cannot otherwise be maintained;
- Emergency C-section requires general anesthesia;
- Emergency medical procedure for a pregnant patient;
- The newborn needs breathing support; or
- The newborn needs emergency resuscitation.
Intubation for Anesthesia During Emergency Medical Procedure
Emergency medical procedures for the mother during pregnancy, during labor, or postpartum may require the patient to go under general anesthesia. “Going under” may be necessary to avoid pain and to keep the patient immobile during the surgery. The anesthesiologist provides drugs that keep the patient's vital signs stable while making them unconscious.
Under general anesthesia, the patient may be unable to breathe on their own and intubation may be required to provide an airway and oxygen supply. After intubation, a ventilator is connected to the endotracheal tube to provide oxygen.
Risks of Infant Brain Damage When the Mother is Not Getting Enough Oxygen
During pregnancy and until the child is delivered, the child receives oxygen and blood from the mother. If the mother's blood flow is threatened or the blood-oxygen levels are too low, it can cause brain damage in the child. It may only take a matter of minutes before hypoxia begins to damage brain cells, which can cause permanent damage.
Intubation for a pregnant mother can be unrelated to labor or childbirth. A pregnant mother can still require emergency care if they are involved in a car accident or have a severe allergic reaction. Anything that causes oxygen compromise or blocks the airway can have a direct impact on the child's oxygen levels.
Wrong Tube Intubation and Birth Injuries
Intubation can be difficult in emergency situations or where the patient suffered severe head or neck trauma. Improper insertion of the tube can cause tissue damage or aspiration of stomach contents. However, the greatest risk for anoxic injuries can be caused by improper intubation to the esophagus. Improper intubation into the esophagus provides false access to the lungs and the patient cannot get oxygen relief, which can lead to brain damage and death for the mother and the unborn child.
Delayed Intubation and Injury to the Child
Failure to intubate a patient and delays in intubation can lead to hypoxic ischemia. Reduced oxygen to the brain or a complete cut off of oxygen supply to the brain can cause brain cells and neurons to suffer damage very quickly. Permanent brain damage to the mother and child can follow after just a few minutes. After about 10 minutes, brain damage can be extensive and after about 15 minutes, recovery and survival may be impossible.
Neonatal and Infant Intubation and Brain Injury
Intubation and ventilation may be required for neonates in intensive care after delivery. Intubation and proper positioning of the endotracheal tube can be more complicated with a neonate or infant, because of the narrow size of the mouth, throat, and tracheal opening.
Neonates and infants with endotracheal tubes require continuous cardiorespiratory monitoring, oxygen saturation, and regular blood pressure monitoring. Any compromise in the oxygen levels because of an intubation error can cause severe brain damage.
In the emergency and elective intubation of a neonate, the child may still require sedatives and analgesics to minimize the effects of intubation. Intubation without sedatives and analgesics can be painful for the newborn, and be associated with other physiologic side-effects, like slow heart rate, low oxygen saturation, and higher blood pressure.
However, there may still be side effects associated with the drugs, which can include atropine, morphine, fentanyl, and muscle relaxants. Some of the side effects may include:
- Allergic reaction
- Rapid heart rate
- Low blood pressure
- Depressed central nervous system
- Lower breathing rate
Long-Term Effects of Intubation Birth Injuries
After the child suffers possible hypoxic-ischemic encephalopathy (HIE) from an intubation error, the child's brain function can be evaluated using imaging technology, including:
- Magnetic resonance imaging (MRI)
- Computed tomography (CT)
- Ultrasonography (US)
However, the long-term effects of intubation birth injuries may not become clear until the child gets older. Some developmental delays may not become evident until the child begins to miss significant developmental milestones. Some of the birth injuries associated with intubation accidents include:
- Cerebral palsy
- Developmental delays
- Cognitive impairment
- Neurodevelopmental delay
- Motor Function impairment
For months or years, parents may have to deal with the unknown of the long-term effects of an intubation error during labor. Even minor impairments may require specialized schooling and accommodations. Major birth injuries can require around-the-clock care for the rest of the child's life.
Intubation Birth Injury Attorneys
If a medical mistake involving intubation caused a birth injury to your child, talk to an experienced medical malpractice attorney about holding the doctors and healthcare systems accountable for their carelessness. Do not hesitate to contact Gilman & Bedigian today for a free consultation.