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You are a paediatric registrar on the children’s intensive care unit. You are about to intubate a 2 year old child with severe meningococcal septicaemia. Your recent experience in ventilating children with this condition is that they often develop acute respiratory distress syndrome, and require high pressures to maintain adequate oxygenation and ventilation. At these high pressures significant leaks occur around the endotracheal tube, impairing effective ventilation, and on occasion it is necessary to change to an endotracheal tube of greater diameter. Re-intubation under such circumstances carries a greater risk of hypoxia because of the inevitable loss of positive airway pressure during the procedure. You think it would be wise to insert a cuffed endotracheal tube, in which the cuff could be inflated if leak becomes a problem. …
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