What occurs when the oral endotracheal tube (ETT) is inserted more than 25 cm?

When an oral endotracheal tube (ETT) is inserted more than 25 cm at the incisors, it typically results in right mainstem intubation. This happens because the right main bronchus is wider and more vertically oriented compared to the left bronchus, making it more likely for the ETT to enter the right bronchus when advanced past the recommended length.

Successful intubation involves placing the ETT such that its tip is in the trachea, allowing for proper ventilation and oxygen delivery to both lungs. However, excessive advancement of the tube can bypass the trachea and go directly into one of the bronchi, with the right mainstem being the most common occurrence when the tube is inserted too far. This can lead to inadequate ventilation of the left lung, resulting in potential complications such as inadequate oxygenation and perfusion of lung tissues.

Proper positioning of the ETT is typically indicated by the tube being placed between 21-25 cm in adults, ensuring that the tip remains in the trachea rather than entering one of the main bronchi. By recognizing the implications of excessive depth of ETT insertion, healthcare providers can mitigate risks associated with airway management and ensure more effective oxygenation during mechanical ventilation