Case 10: Changing a Nasotracheal Tube for an Oral Tube in the Intensive Care Unit

  • John G. Brock-Utne


A 10-year-old boy, otherwise healthy, is admitted to the trauma center after a motor vehicle accident. He has suffered a fracture of the second cervical vertebrae without neurologic deficit. The fracture is managed with the application of a halo-fixator, and he is observed in the intensive care unit (ICU). Twenty-four hours later, he develops respiratory distress and pulmonary congestion. An electrocardiogram (ECG) reveals moderate aortic valve regurgitation, probably as a result of the blunt chest trauma. A decision is made to treat the pulmonary edema with tracheal intubation and intermittent positive pressure ventilator. The halo-fixator makes direct laryngoscopy impossible. A nasal endotracheal intubation is undertaken using the fiber-optic bronchoscope, without incident.




  1. 1.
    Hambly PR, Field JM. An unusual case for reintubation. Anaesthesia. 1995;50:568.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • John G. Brock-Utne
    • 1
  1. 1.Department of AnesthesiaStanford UniversityStanfordUSA

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