Key messages

• Intubation of the airway increases resistance to gas flow and may increase functional residual capacity, thus increasing respiratory work.

• The anatomical dead-space is reduced by the intubation, but the connecting tubing and any humidifier applied to the respiratory circuit result in an overall increase in respiratory dead-space. This increases the ventilatory demand.

• Bypassing of the nose and the upper airway by the artificial airway interferes with the conditioning of the inspired gas (humidification, heating, and removal of larger particles). The distal end of the tube and the sealing cuff may damage the airway wall and cause infection and stenosis.

• Intubation of the airway will prevent autoinhalation of endogenously produced nasal nitric oxide with possible negative effects on ventilation-perfusion matching.

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