how an ETT may be malpositioned; list other potential complications of ETT placement.
If an ETT is inserted beyond the carina (i.e., with unilateral bronchial intubation), preferential hyperaeration and potential barotrauma of the intubated lung (more commonly the right) and hypoaeration and atelectasis of the contralateral lung may occur. If the tube is not advanced far enough, inadvertent extubation or possible vocal cord damage caused by the inflated cuff may occur. Esophageal intubation is another potential complication, which can be detected clinically by gurgling sounds and distention of the stomach as air is insufflated and radiographically by lateral extension of the tube margins beyond the tracheal margins, visualization of the tracheal air column to the side of the tube, gastric distention, and lung hypoinflation. Other complications of ETT placement include:
- • Pharyngeal, laryngeal, or tracheobronchial injury (particularly if placed too high or if the cuff is overinflated).
- • Aspiration.
- • Sinusitis.
- • Dislodgment of teeth or dental appliances.