The left lung isn't being ventilated, so the patient starts to desaturate. The ICU is noisy, masking any difference in bilateral breath sounds. Unfortunately, your patient is small, so the tube ends up in the right mainstem bronchus. Fantastic! You secure the endotracheal tube at 22cm. You pre-oxygenate the patient and perform a beautiful intubation on the first attempt. Imagine that you are intubating a patient with ARDS. Introduction with a rare but recurrent error pattern Meanwhile, this is often the point when the patient's blood pressure and saturation nadir. There is a risk of relaxing and overlooking critical details. According to Napoleon, “the moment of greatest vulnerability is the instant immediately after victory.” In airway management, this instant occurs immediately after placement of the endotracheal tube.
