Mechanical

Tube exchange / cuff leak / damaged ETT

Before / During / After / Pitfalls

Before

• Decide if leak is tolerable, positional, pilot-balloon/cuff failure, or tube damage.
• Have airway exchange catheter, backup airway team, suction, and reintubation plan ready.
• If difficult airway, do not casually extubate to exchange.

During

• Maintain oxygenation; perform exchange with skilled operator and rescue plan.
• Confirm new tube with waveform EtCO₂ and depth.
• Do not lose the airway for a non-emergent leak without preparation.

After

• Reassess cuff pressure, leak, depth, ventilator volumes, and aspiration risk.
• Communicate difficult exchange details.
• Document old/new tube sizes and technique.

Pitfalls

• Pulling the tube before a reintubation plan.
• Ignoring a large leak causing inadequate ventilation.
• No EtCO₂ after exchange.