Differential diagnosis of pediatric endotracheal tube malfunction

• Endotracheal tube in high position
• Endotracheal tube in right mainstem bronchus causing partial atelectasis of left lung
• Endotracheal tube in right mainstem bronchus causing complete atelectasis of left lung
• Endotracheal tube in right mainstem bronchus causing partial atelectasis of right lung
• Endotracheal tube in right mainstem bronchus causing pneumothorax
• Endotracheal tube in esophagus

Approach to the differential diagnosis of endotracheal tube malfunction:

• Endotracheal tube tip should lie between the thoracic inlet and the carina – any other position requires repositioning
• Endotracheal tube tip apparent position is influenced by whether the neck is in flexion, neutral or extended position so consideration should be paid to neck position when determining endotracheal tube tip position
• Endotracheal tube should usually overlie the right side of the spine, if it overlies the left side of the spine check for esophageal or gastric distension and consider esophageal intubation
• Any time atelectasis is seen after intubation check endotracheal tube tip position carefully