ICU Chest Films > Lines and Tubes > Major Complications

Major Complications of Endotracheal Tubes

Lateral radiographs are useful when an upper airway injury is suspected. Widening of the soft tissues between the trachea and cervical spine is often present when there is a space-occupying lesion such as a hematoma. Unfortunately, injury to the vocal cords, such as cord paralysis, is not evident until the patient is extubated. Catastrophic injury to the trachea, such as tracheal rupture, should be suspected in patients with pneumothorax, pneumomediastinum, subcutaneous emphysema in the neck or precipitous respiratory failure following intubation. Tracheal rupture usually occurs posteriorly through the membranous portion of the distal trachea or through the proximal main bronchi.

What are some early radiographic clues to tracheal rupture? (More than one)
Migration of the endotracheal tube distally
Increased ventilation of lungs
Enlargement of the endotracheal cuff balloon
Decrease in diameter of the endotracheal cuff balloon