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Endotracheal tube management and complications

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


The primary goal of endotracheal tube (ETT) management is prevention of complications. However, adverse events occasionally occur despite proper management. Clinicians must be prepared to recognize and manage such complications.

This topic reviews basic aspects of ETT management, including positioning, cuff pressure, and suctioning. Complications related to endotracheal intubation are also described. Tracheostomy is discussed separately. (See "Overview of tracheostomy".)


Complications of the intubation procedure are common. In a series of over 3400 emergent intubations, the incidence of difficult intubation was 10 percent [1]. Airway-related complications occurred in four percent of the patients, which included aspiration, esophageal intubation, dental injury, and pneumothorax. Independent risk factors for complications from intubation included three or more intubation attempts, intubation on the general floor or in the emergency room, and a grade III or grade IV view of the airway (figure 1). Neuromuscular blockade was utilized in 73 percent of the intubations.

An intubation care bundle or video assistance may be useful in decreasing the rate of post-intubation complications [2,3]. Such intervention bundles may require the presence of two operators, preoxygenation, intravascular volume loading (unless cardiogenic edema is present), rapid sequence technique, and capnography post placement.


Orotracheal intubation is the most common method of inserting an ETT [4]. Nasotracheal intubation is also possible, but much less common. Regardless of whether orotracheal or nasotracheal intubation is performed, the method for evaluating the position of the ETT following intubation is the same:


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Literature review current through: Aug 2016. | This topic last updated: Mar 17, 2016.
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