Chapter 36 ■ Endotracheal Intubation 247

Fig. 36.21. Radiograph demonstrating an endotracheal tube

malpositioned in the bronchus intermedius, with resulting atelectasis of the right upper lobe and of the left lung. There is marked

overaeration of the right middle and lower lobes but no pneumothorax shown.

Fig. 36.18. Palatal groove after prolonged oral intubation.

Such grooves may be seen after prolonged use of endotracheal or

oral gastric tubes when the normal forces of the tongue are prevented from assisting palatal development.

Fig. 36.19. Acquired oral commissure defect: a complication

of prolonged endotracheal intubation. (Reprinted by permission

from Macmillan Publishers Ltd. J Perinatol. 2005;25:612.)

Fig. 36.20. Nasal stenosis due to nasal cartilage necrosis following an indwelling nasotracheal tube.

248 Section VI ■ Respiratory Care

Fig. 36.22. Relatively uncommon malposition of an endotracheal tube in the left bronchus with atelectasis of much of the

right lung.

c. Increased intracranial pressure

d. Hypoxemia

e. Hypertension

f. Apnea

g. Bradycardia and cardiac arrest

6. Misplacements into esophagus or bronchus (32,33)

(Figs. 36.21 through 36.23)

a. Atelectasis

b. Pulmonary air leak

c. Loss of tube into esophagus

d. Tube crosses tracheoesophageal fistula

7. Displacement; accidental extubation (11,14)

8. Obstruction (34)

9. Kinking, proximally or distally

10. Unrecognized disconnection from adapter or pressure

source

11. Rupture of endotracheal tube (35)

12. Foreign body from stylet left unrecognized in airway

13. Swallowed laryngoscope light (36)

14. Postextubation atelectasis (35)

15. Increased airway resistance increasing work of breathing (37)

A B

Fig. 36.23. A: Radiograph suggesting that the endotracheal tube is in the right mainstem bronchus.

Note the gaseous distension of the stomach. The wavy tube on the right is external. B: In the lateral view,

the same endotracheal tube is easily seen to be in the esophagus (arrowheads) posterior to the trachea

(arrows).