Emergency physicians rarely are involved in tube exchanges; I can’t remember the last time I had to do one. However, during the COVID19 surge, we found ourselves boarding intubated patients for days and even weeks as our ICUs were filled to the brim.

With our ICU teams so busy, it became increasingly important for us to aid in critical care management where we could.

Initially this was simply with lines and hemodynamic monitoring but, tube exchange became important. A number of our boarding patients developed considerable mucous plugging and tube obstruction that could not be cleared by suction.

Reintubation with a fresh tube, while well within our scope, creates unnecessary risks – aerosol generation, increased provider exposure and possible harm to patient if intubation proves challenging. Tube exchange over a bougie seems to make a lot of sense.

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