Breathing Through the Nose While Intubated
No, patients do not breathe through their nose while intubated with an endotracheal tube—the endotracheal tube bypasses the nose and mouth entirely, delivering air directly into the trachea and lungs. 1
How Endotracheal Intubation Works
The endotracheal tube is inserted through either the mouth (orotracheal) or nose (nasotracheal) and advanced past the vocal cords into the trachea, creating a direct conduit from the ventilator to the lower airways 2
Once the tube is properly positioned in the trachea with an inflated cuff, it creates a sealed airway that completely bypasses the upper airway structures including the nose, mouth, and pharynx 2
All ventilation occurs through the endotracheal tube itself—the ventilator delivers oxygen and air directly through the tube into the trachea and lungs 2, 3
Why the Nose Is Not Involved in Breathing
The inflated cuff on the endotracheal tube seals against the tracheal wall, preventing air from moving around the tube and eliminating any airflow through the nose or mouth 2
This seal is essential to prevent aspiration of secretions and to ensure effective positive-pressure ventilation during mechanical ventilation 2
Even with nasotracheal intubation (tube inserted through the nose), the tube passes through the nasal cavity but breathing still occurs only through the tube lumen, not through the nasal passages themselves 2, 4
Clinical Implications
Nasal intubation may be preferred over oral intubation in certain situations (such as with excessive oral secretions or need for prolonged intubation) because it is more secure and less likely to be dislodged, but this does not mean breathing occurs through the nose 2
Regular suctioning of airways is necessary because secretions can accumulate above the endotracheal tube cuff in the pharynx, but these secretions are separate from the ventilation pathway 2
The presence of the endotracheal tube with proper cuff inflation protects against aspiration precisely because it isolates the lower airway from the upper airway, nose, and mouth 2