Migrated ETT on Transfer

Published 22/12/2022

Migrated ETT on Transfer




RIJ CVC & right radial arterial line


Propofol, remifentanil, noradrenaline 0.3mcgs/kg/min, 1L crystalloid at 100ml/hr


ETT 24cm at lips, loosely secured (documented at ETT 21cm at lips on chart/computer)


P-SIMV 14/8 FiO2 0.3 Rate 16 breaths/min. Transfer ventilator off but still at bedspace.


Lung simulator with capability of reducing compliance (see videos)

Clinical Setting

I: You are the ICU doctor receiving the patient back from the CT scanner. The doctor performing the transfer has handed over to the bedside nurse and left.

S: Bedside nurse is transferring patient back onto ICU ventilator from transfer ventilator and notes tidal volume less than when they left

B: 65 year old patient admitted to ICU with hypoxaemic respiratory failure due to a presumed CAP. CTPA to exclude pulmonary embolism.

A: Low tidal volumes on portable ventilator with high airway pressures.

R: Called for help

Potential Clinical Course:

  • Initially A ETT 24cm at lips, B SpO2 99% on FiO2 1.0 PSIMV at 16bpm, low tidal volumes, ETCO2 5 kPa, no breath sounds left side, C HR95bpm SR, BP 118/62, D Deeply sedated (not paralysed)
  • Low VTs, climbing ETCO2, slow desaturation
  • No change on ICU ventilator. Nurse reports settings same as before transfer
  • Examination- patent ETT 24cm at lips, tube loosely secured, silent left lung, unilateral chest expansion on right side
  • Saturations continue to fall despite 100% FiO2
  • ETT patent- can pass suction catheter
  • If ETT withdrawn- ventilation improves and saturations climb

Info Sheet For Faculty

  • Initial settings:    
    • SpO2 95% on FiO2 1
    • ETCO2 5.1kPa
    • RR 16/min
    • Quiet breath sounds left lung
    • HR 95bpm
    • BP 118/62


  • Progress to:    SpO2 92% on FiO2 1.0
    • ETCO2 6.0kPa
    • No breath sounds left lung/ not expanding
    • HR 100bpm
    • BP 105/60


  • Progress to:    SpO2 85% on FiO2 1.0
    • ETCO2 6.9kPa
    • No breath sounds left lung/ not expanding
    • HR 118bpm
    • BP 95/60


  • On withdrawal of ETT (remove restriction on lung simulator)
    • SpO2 climb to 94% on FiO2 1.0
    • ETCO2 5.6kPa
    • Breath sounds bilaterally but reduced left base. Bilateral expansion
    • HR 108bpm
    • BP 108/68

Faculty Roles

Bedside Nurse 1:

  • You are an ICU nurse who has recently completed your transfer training
  • You have returned from transferring a 65M with presumed CAP back to ICU with one of the registrars
  • You have no concerns except that the tidal volumes are a little less than before transfer
  • If asked why you think the tidal volumes are low volunteer that the patient may have “de recruited” on switching ventilators
  • If the candidate asks guide the participant to where the ETT depth is documented as “21cm at the teeth” within the bedspace


Bedside Nurse 2:

  • You are a student nurse on critical care placement
  • You are responsible for manipulating the lung simulator if using simple test lung as per videos