Endotracheal tube migration and cuff leak Critical Care
Endotracheal tube migration and cuff leak Critical Care Tips and Tricks for junior doctors AIM: To provide a safe framework for new non-anaesthetic doctors working in Critical Care to appropriately manage problems with ETT when asked to review a patient. It does not equate to advanced airway training. SCOPE: Adult patients ventilated in Critical Care. Often you will be called to check a patients tube because it has moved. Step 1: Is the patient ventilating? No If not ventilating: CALL FOR HELP 2222 ‘Anaesthetic emergency or Fast Bleep ITU Sp. R’ Rapid ABC assessment initiate ALS as appropriate Y e s Step 2: Is there high airway pressure? Yes • • Give 100% O 2 Auscultate both axilla If unilateral AE organise CXR Call ITU Sp. R High airway pressures may indicate endobronchial intubation Adjust ETT position ITU Sp. R only Repeat CXR N o Step 3: Is there an audible leak? Yes • • 10/09/2021 Give 100% O 2 Listen for audible leak Check ventilator to quantify leak Auscultate both axilla If concerned call ITU Sp. R If nurse reports high cuff pressures needed to reduce leak – may indicated herniation through cords, cuff damage, valve damage – call ITU Sp. R Adjust ETT position or re-intubate ITU Sp. R only Repeat CXR Written by Patrick Thorburn v 1. 0
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