Endotracheal tube replacement in a neonate using an airway exchange catheter

Traditional tracheal intubation is carried out using direct laryngoscopy. Devices to facilitate tracheal intubation have been developed, the first of which was the gum elastic bougie by McIntosh. (1) Since then, tracheal introducer devices such as intubating stylets, bougies, and airway exchange catheters (AECs) have been developed to facilitate tracheal intubation under varying conditions, particularly in patients with a difficult airway and during emergent airway management. (2) Although stylets and bougies are more rigid and solid, AECs have a hollow lumen (Fig 1A) and a side opening at the distal tip. Endotracheal tubes (ETTs) sometimes require replacement in patients in intensive care units or during surgery. In children and adults, ETTs can be replaced without resorting to direct laryngoscopy using flexible bronchoscopes, over bougies or using flexible AECs.