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Complications of the endotracheal tube following initial placement: Prevention and management in adult intensive care unit patients

Robert C Hyzy, MD
Section Editor
Scott Manaker, MD, PhD
Deputy Editor
Geraldine Finlay, MD


Many complications associated with oral endotracheal tubes (ETTs) occur during initial placement. However, ETTs are also associated with complications following placement that can occur during the ensuing days to weeks of intensive care unit (ICU) admission.

This topic reviews basic aspects of prevention and treatment of complications associated with oral ETTs pertinent to the adult ICU patient. Intubation techniques, checking ETT position after initial placement, and immediate complications of ETT as well as complications associated with placement of supraglottic airway devices are discussed separately. (See "Overview of tracheostomy" and "Direct laryngoscopy and endotracheal intubation in adults" and "Rapid sequence intubation for adults outside the operating room" and "Induction agents for rapid sequence intubation in adults outside the operating room" and "Neuromuscular blocking agents (NMBAs) for rapid sequence intubation in adults outside of the operating room" and "Supraglottic devices (including laryngeal mask airways) for airway management for anesthesia in adults".)


Direct versus video laryngoscopy — Direct laryngoscopy is the traditional method used to intubate patients in the intensive care unit (ICU). However, video laryngoscopy is being increasingly used [1-3]. Choosing among these options and role of video laryngoscopy for endotracheal tube exchange in the ICU are discussed separately. (See "Approach to the difficult airway in adults outside the operating room" and "Video laryngoscopes and optical stylets for airway management for anesthesia in adults" and 'Exchanging the endotracheal tube' below.)

Immediate complications — This topic review discusses complications that occur in the intensive care unit following appropriate ETT placement. Complications that occur during or following intubation and ETT placement are discussed in detail separately. (See "Direct laryngoscopy and endotracheal intubation in adults".)


Daily endotracheal tube care should be provided to avoid complications associated with ETTs. Daily care includes monitoring ETT cuff pressure, oral and endotracheal suctioning of secretions, and vigilant inspection to ensure that the ETT is rotated regularly and its position maintained. These preventative measures are especially important in those identified as having a difficult airway since reintubation is particularly risky and challenging in this population.  


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Literature review current through: Jun 2017. | This topic last updated: Mar 06, 2017.
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