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Endotracheal Tube Replacement in a Neonate Using an Airway Exchange Catheter

Rachel Witt, Lisa Chi, Chandra Kellner, Amanda Chamness, Katie Kigin and Rakesh Rao
NeoReviews November 2020, 21 (11) e782-e786; DOI: https://doi.org/10.1542/neo.21-11-e782
Rachel Witt
*Washington University School of Medicine, St. Louis, MO
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Lisa Chi
*Washington University School of Medicine, St. Louis, MO
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Chandra Kellner
†St. Louis Children’s Hospital, St. Louis, MO
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Amanda Chamness
†St. Louis Children’s Hospital, St. Louis, MO
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Katie Kigin
†St. Louis Children’s Hospital, St. Louis, MO
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Rakesh Rao
*Washington University School of Medicine, St. Louis, MO
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Background

Traditional tracheal intubation is carried out using direct laryngoscopy. Devices to facilitate tracheal intubation have been developed, the first of which was the gum elastic bougie by McIntosh. (1) Since then, tracheal introducer devices such as intubating stylets, bougies, and airway exchange catheters (AECs) have been developed to facilitate tracheal intubation under varying conditions, particularly in patients with a difficult airway and during emergent airway management. (2) Although stylets and bougies are more rigid and solid, AECs have a hollow lumen (Fig 1A) and a side opening at the distal tip.

Figure 1.

A. An airway exchange catheter (AEC) is a hollow tube. B. Rapi-fit adapter (left) and adapter for jet ventilation (right). C. Rapi-fit adapter attached to AEC. D. Distal tip showing side port opening.

Endotracheal tubes (ETTs) sometimes require replacement in patients in intensive care units or during surgery. In children and adults, ETTs can be replaced without resorting to direct laryngoscopy using flexible bronchoscopes, over bougies or using flexible AECs.

Brief Review

AECs are part of the armamentarium for the management of a difficult airway in children and adults. They are recommended by the Difficult Airway Society to facilitate intubations as well as to decrease extubation failures. (3) For the latter, AECs are left in situ as a tracheal conduit to allow airway rescue, as well as a means to provide oxygenation. (3)(4)(5) AECs have been used in intensive care units, in trauma, and during surgeries to either facilitate intubations or replace ETTs. They can be used as a guidewire for replacing an ETT or mounted over a flexible bronchoscope to facilitate tracheal intubation under direct visualization. Other clinicians have used AECs for exchanging a double lumen ETT for a single lumen ETT and as educational tools to guide tracheal intubation via supraglottic airway devices such as …

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Vol. 21, Issue 11
1 Nov 2020
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Endotracheal Tube Replacement in a Neonate Using an Airway Exchange Catheter
Rachel Witt, Lisa Chi, Chandra Kellner, Amanda Chamness, Katie Kigin, Rakesh Rao
NeoReviews Nov 2020, 21 (11) e782-e786; DOI: 10.1542/neo.21-11-e782

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Endotracheal Tube Replacement in a Neonate Using an Airway Exchange Catheter
Rachel Witt, Lisa Chi, Chandra Kellner, Amanda Chamness, Katie Kigin, Rakesh Rao
NeoReviews Nov 2020, 21 (11) e782-e786; DOI: 10.1542/neo.21-11-e782
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