| Summary: | Endotracheal intubation is a procedure performed by multiple medical specialists in various clinical scenarios. Difficulties with direct laryngoscopy and placement of an endotracheal tube (ETT) have received significant atten- tion in the literature with the production of guidelines for dealing with scenarios during which bag-valve-mask ventilation or endotracheal intubation are problematic or impossible. However, there has been less attention paid to problems arising following placement of the ETT. Kinking of an ETT can simulate other ventilatory issues including ventilator malfunction, mucus plugging, bron- chospasm, ETT obstruction, bronchial intubation,
pulmonary edema, pneumothorax, aspiration, or pneu- monia. We present two pediatric patients who developed altered respiratory compliance intraoperatively that was eventually determined to be the result of a kinked ETT. Previous reports of such problems are reviewed, an algo- rithm for determining the etiology of altered intraopera- tive compliance presented, and techniques to prevent the problem are discussed.
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