Wednesday, October 30, 2019

ETT exchange

Q: Video laryngoscopy is recommended for the Endo-tracheal tube (ETT) exchange? 

A) True
B) False

Answer: A

Exchange of ETT is a serious business as it can very quickly degenerate into a life-threatening situation with loss of airway leading to cardiac arrest. It should be carried out by an experienced provider or at least with an immediate backup of an expert. Usually, exchange of ETT is carried out in similar fashion as the placement of a new ETT. The same level of vigilance, preparation and medications should be used. It is usually of help to visualize the vocal cord prior to exchange of ETT with direct blade or video laryngoscope. 

At least one recent prospective study of 328 patients in whom the vocal cords were not easily visualized using direct blade laryngoscopy, comparing with historical controls, video laryngoscopy reduced the number of attempts for ETT exchange from 92 to 68 percent in first attempt, and lesser complications such as hypoxemia, esophageal intubation, bradycardia, and need for back up.



Mort TC, Braffett BH. Conventional Versus Video Laryngoscopy for Tracheal Tube Exchange: Glottic Visualization, Success Rates, Complications, and Rescue Alternatives in the High-Risk Difficult Airway Patient. Anesth Analg 2015; 121:440.

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