Question

You are caring for a 6-year-old patient who is receiving positive-pressure mechanical ventilation via an ET tube. The child begins to move his head and suddenly becomes cyanotic, and his HR decreases. His SpO2 is 65%. You remove the child from the mechanical ventilator and begin to provide manual ventilation with a bag via the ET tube. During manual ventilation with 100% oxygen, the child's color and HR improve slightly but his BP remains inadequate. Breath sounds and chest expansion are present and adequate on the R side and are present but consistently diminished on the L side. The trachea is not deviated, and the neck veins are not distended. A suction catheter passes easily beyond the tip of the ET tube. What is the most likely cause of this child's acute deterioration?

Answer 1

The most likely cause of this child's acute deterioration is a left mainstem bronchus intubation, where the endotracheal tube is placed too far and only ventilates the right lung. Repositioning the tube to ensure proper ventilation of both lungs is necessary for improvement.

Step-by-step explanation:

The most likely cause of this child's acute deterioration is a left mainstem bronchus intubation. This occurs when the endotracheal tube is placed too far down the trachea and enters the left mainstem bronchus, leading to ventilation of only the right lung. Due to inadequate ventilation of the left lung, breath sounds and chest expansion on the left side are diminished. This can result in decreased oxygenation, cyanosis, and a decrease in heart rate.

In this case, removing the child from the mechanical ventilator and providing manual ventilation with 100% oxygen improved the child's color and heart rate slightly, but the blood pressure remained inadequate, indicating poor perfusion to the left lung. The ability of the suction catheter to pass easily beyond the tip of the endotracheal tube also suggests that the tube is positioned too deep.

It is important to reposition the endotracheal tube to ensure proper ventilation of both lungs. This can typically be done by withdrawing the tube slightly until bilateral breath sounds and chest expansion are present. Once the tube is repositioned, oxygenation and perfusion to both lungs should improve, leading to improved vital signs.