Key points Intubation of a bronchus may lead to lung or lobar collapse Accidental intubation of a bronchus is more common on the right If inserted too far, an endotracheal tube (ET tube) can enter the right or left main bronchus. This results in ventilation of a single lung and can result in collapse of the contralateral lung or a lobe of the intubated lung.
Accidental intubation of a bronchus is more common on the right because the right main bronchus is more vertically orientated than the left main bronchus.
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ET tube misplaced at carina This ET tube tip is incorrectly located at the level of the carina and nearly enters the right main bronchus Although both lungs are currently ventilated there is a risk of intubation of a single bronchus on neck movement This tube should be repositioned by a trained individual Hover on/off image to show/hide findings
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ET tube misplaced in right main bronchus The ET tube has entered the right main bronchus This tube should be repositioned by a trained individual ET tube misplacement with lung collapse Intubation of a bronchus may result in collapse of the contralateral lung.
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Misplaced ET tube with lung collapse The ET tube is within the right main bronchus The tube and its cuff occlude the orifice of the left main bronchus which is not visible Consequently the left lung is not ventilated and has collapsed Barotrauma Complications of mechanical ventilation such as pneumothorax, pneumomediastinum and surgical emphysema may be visible on a chest X-ray.
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Pneumomediastinum and surgical emphysema The ET tube tip is adequately positioned, 5 cm above the carina Surgical emphysema is readily visible in the soft tissues of the neck on the right Pneumomediastinum (gas in the soft tissues of the mediastinum) is often more difficult to identify In this image the mediastinum is outlined by a thin white line (arrowheads ) This line is the mediastinal pleura which is separated from the mediastinum by gas These are the typical appearances of pneumomediastinum Oesophageal intubation Oesophageal intubation may be a fatal complication and should be detected clinically before a patient is sent for a chest X-ray.
