Question 23 from the second paper of 2005 asked the candidate to "list the potential adverse effects of endotracheal intubation". Judging from the college answer, they were after the specific complications of intubation, rather than the broader complications of invasive mechanical ventilation.

With only a few additional embellishments, the following table of complications and their solutions is presented here copied and pasted straight from Question 23. The model for this table was the excellent review article by Divatia and Bhowmick (2005), which can be recommended as the one article you need to read for this topic.

Complication

Preventative measure

Failure of intubation

Oesophageal intubation

  • Visual confirmation of ETT position
  • Capnometry
  • Auscultation of the chest

Right main bronchus intubation

  • auscultation of both lungs
  • chest Xray
  • Bronchoscopic confirmation

Bronchospasm

  • Pre-intubation nebulised salbutamol or adrenaline

Hypoxia

  • Pre-oxygenation
  • Continuous pulse oximetry

Aspiration

  • Cricoid pressure (debatable)
  • Aspiration of stomach contents by NG tube
  • Fasting the patient in preparation
  • Careful bag-mask ventilation to prevent gastric inflation
  • Alternatively: do not bag-mask ventilate (RSI)

Pneumothorax and tension pneumothorax

  • Use of moderation in bag-mask ventilation volumes
  • Post-intubation CXR

Cuff leak

  • Select a size-appropriate tube

Myocardial ischaemia

  • Use of opiate analgesics as part of intubation drug cocktail to prevent the sympathetic response to laryngoscopy
  • Anaesthtising the vocal cords

Spinal injury

  • Correctly identify patients at risk of spinal injury, and use of inline stabilisation
  • Fiberoptic bronchoscopy

Increased intracranial pressure

  • Use of opiate analgesics as part of intubation drug cocktail to prevent the sympathetic response to laryngoscopy
  • Hyperventilation with bag to decrease CO2 post intubation

Increased intraocular pressure

  • Use of opiate analgesics as part of intubation drug cocktail to prevent the sympathetic response to laryngoscopy
  • Anaesthtising the vocal cords

Structural damage:

-lips
-teeth
-tongue

  • Skilled practitioner
  • Limit the number of attempts by unskilled practitioners
  • Videolaryngoscopy
  • Avoid the use of stylet or bougie
  • Ensure the tip of the stylet is well within the ETT when it is advanced (i.e. not sticking out past the end of the ETT)

References

Griesdale, Donald EG, et al. "Complications of endotracheal intubation in the critically ill." Intensive care medicine 34.10 (2008): 1835-1842.

Rashkin, Mitchell C., and Tern Davis. "Acute complications of endotracheal intubation. Relationship to reintubation, route, urgency, and duration." CHEST Journal 89.2 (1986): 165-167.

Divatia, J. V., and K. Bhowmick. "Complications of endotracheal intubation and other airway management procedures." Indian J Anaesth 49.4 (2005): 308-18.