Endotracheal Tube Replacement in a Neonate Using an Airway Exchange Catheter

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.

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 …