Adult Critical Care Specialty (ACCS) Practice Exam

If a patient is intubated but exhibits no improvement, what would be the next step in management?

1. Replace the ET tube

2. Increase sedation

3. Initiate emergency resuscitation

4. Change the device positioning

The correct answer is: Replace the ET tube

In a scenario where a patient is intubated but shows no improvement, the appropriate next step in management is to replace the endotracheal (ET) tube. This decision stems from the possibility that the current ET tube may be malfunctioning or improperly positioned, leading to inadequate ventilation and oxygenation. If the ET tube is obstructed, incorrectly placed, or has a cuff leak, the patient's condition could deteriorate despite being on mechanical ventilation. In such cases, replacing the ET tube allows for reassessment of the airway and ensures that the patient is receiving adequate ventilation and oxygen delivery. It's crucial to ensure that the airway is maintained effectively, which directly impacts the patient's respiratory status and overall prognosis. The other options may not directly address the underlying issue of the patient's lack of improvement. Increasing sedation could potentially worsen the airway management issue if the patient's respiratory drive decreases further. Initiating emergency resuscitation may be necessary in cases of cardiac arrest or extreme deterioration, but it doesn't specifically resolve the problem related to the ET tube. Changing the device positioning might provide temporary relief, but if the overall function of the tube is compromised, it would not be an effective long-term solution. Therefore, replacing the ET tube is a focused approach that addresses the core problem