Your patient who is orally intubated and receiving mechanical ventilation was just repositioned by the nursing staff following their bedsheets being changed. Suddenly, airway pressures and tidal volumes rapidly decrease

Which of the following explains this finding?
a. Pneumothorax.
b. A dislodged mucus plug is obstructing the endotracheal tube.
c. Acute bronchospasm.
d. Movement of the endotracheal tube.

ANS: D
Another common problem with endotracheal tubes is movement of the airway into the oral phar-ynx or movement into the right main stem bronchus. Both of which can be life threatening alt-hough movement into the oral pharynx, essentially extubation, is the most life threatening. In some situations the airway can be moved back into the trachea, in others reintubation is neces-sary. If this occurs adequate ventilation is generally impossible. Airway pressures and tidal vol-umes rapidly decrease and there is frequent gas leakage from the mouth and nose. It is thus im-portant to determine at each patient-ventilator assessment the location of the endotracheal tube.