A child orally intubated because of laryngotracheal stenosis has an air leak at 25 cm H₂O. What action does the therapist take now?

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Children with laryngotracheal stenosis who do not have a tracheotomy may require intubation. The severity of the stenosis may dictate the approach used to access the airway. Plain magnified soft tissue radiographs may show subglottic narrowing or long-segment tracheal stenosis. In cases of mild subglottic stenosis, the patient may be intubated orally, but it would be essential to start with an endotracheal tube size at least one smaller than the age-appropriate tube, and air leakage must be checked. A leak between 10 and 20 cm H₂O during the time of intubation is necessary so that further damage is not incurred. If the air leak is greater than 20 cm H₂O, a smaller tube should be placed. In cases of severe laryngotracheal stenosis, an LMA may be used, or occasionally an emergency tracheotomy may be performed as an alternative.

A Child Orally Intubated Because of Laryngotracheal Stenosis Has an Air