Question

A 5'6" female has been transferred from Intermediate Care to Intensive Care in respiratory distress. She is intubated with a silver-coated #7.0 Endotracheal tube. CXR immediately following intubation shows Right Upper Lobe infiltrate with bibasilar atelectasis. The ET Tube is noted to be approximately 4 cm above the carina.

The Respiratory Therapist would BEST recommend:

A) Initiation of broad-spectrum antibiotics for probably pneumonia
B)Withdraw Endotracheal tube at least 3 cm
C) Use tube exchanger to replace Endotracheal tube from silver-coated to a low-pressure/high-volume cuffed tube
D) Immediate V/Q Scan

Answer 1

The Respiratory Therapist would best recommend withdrawing the endotracheal tube at least 3 cm. The current tube placement is causing ventilation to be skewed towards the right side, resulting in right upper lobe infiltrate and bibasilar atelectasis. Initiating broad-spectrum antibiotics for probable pneumonia or replacing the tube is not indicated.

Step-by-step explanation:

The best recommendation from the Respiratory Therapist in this scenario is to withdraw the endotracheal tube at least 3 cm. The CXR findings of right upper lobe infiltrate with bibasilar atelectasis suggest that the current tube placement is causing ventilation to be skewed towards the right side. By withdrawing the tube, the level of ventilation to the lungs can be better distributed and atelectasis can be resolved. Initiating broad-spectrum antibiotics for probable pneumonia is not appropriate in this case, as the infiltrate is likely due to atelectasis caused by the tube position, and not an infection. Replacing the silver-coated tube with a low-pressure/high-volume cuffed tube using a tube exchanger is not necessary at this point, as the main issue is the positioning of the tube.