Question

Once you have the endotracheal tube in place, and as you perform auscultation, you realize the patients right side has sounds from the lungs but the left does not, or they are minimal. What should be your next move?

A) Extract the tube and try intubation again
B) Abandon it and initiate respirations
C) Ensure the cuff is deflated, then pull the tube three to four centimeters
D) Gently pull the tube three to four inches out, ensuring cuff is inflated

Answer 1

If only one lung seems to be ventilating post-intubation, one should deflate the endotracheal tube cuff and pull back the tube slightly (3-4 cm) to achieve bilateral lung ventilation and to prevent atelectasis or pneumothorax.

Step-by-step explanation:

When auscultating breath sounds post-intubation and noting an absence or minimal sounds on one side, the appropriate next step would be C) Ensure the cuff is deflated, then pull the tube three to four centimeters. This action hints at possible right mainstem bronchus intubation, where the endotracheal tube may have been inserted too deeply, ventilating only one lung (typically the right). Auscultation during and after intubation is essential to confirm correct placement of the endotracheal tube and symmetrical lung inflation.

If breath sounds are not heard equally on both sides, the tube might be in too far, reaching one of the main bronchi, often the right side due to its vertical alignment with the trachea. By deflating the cuff and slightly retracting the tube, you can reposition it to ensure both lungs receive adequate ventilation. This adjustment helps prevent complications such as atelectasis or pneumothorax and ensures proper mechanical ventilation which is crucial for patient care in situations of respiratory compromise.