This is the podcast, ICU rounds.

My name is Dr. Jeffrey Guy.

I'm an associate professor of surgery and director of the Burns Center at the Vanderbilt

University School of Medicine in Nashville, Tennessee.

Hi, welcome back to the podcast.

The topic that I want to discuss today is one of practical importance, and that is what do you do when you're called by the intensive care unit

and you're told that the patient who's on a mechanical ventilator who's orally intubated has a significant cuff leak,

and they're having a little bit of difficult time

ventilating the patient.

And, you know, what is the thought process that goes in the evaluation of that patient

and how do we go about basically fixing the problem?

Well, first of all, you need to kind of recognize that even a bad airway is better than no airway.

So you don't want to make any impestuous decisions.

I remember once getting called one night on call, and I was called to the SICU, and there was a morbidly obese male who was there for some gastric bypass surgery.

The patient was mechanically ventilated

in the postoperative period. And I was called and said that they were just changed out

the nitracheal tube. I really wanted to kind of put the break on that and say, let's slow down,

let's see what's going on, and let's kind of really assess what's really happening here.

Because remember, people don't die for lack of a piece of plastic.

They die because lack of patency of an airway. And so what happens, in my opinion, all too often

is that when we say A is for airway, people take that A as for airway and think airway as a noun.

Airway is actually should be approached as airway being a

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