To the Editor: Changing an endotracheal tube (ETT) in critically ill patients with severe airway edema is challenging and potentially life threatening. We describe an alternative to tube exchange for an ETT that was too short in length. A 170 cm tall pregnant 35-yr-old female at 30 weeks gestation was involved in a motor vehicle acci- dent. Although initially awake, her condition deteriorated. Awake intubation using direct laryngoscopy by attending anesthesiologists was successful on the third attempt with a 7.0-mm internal diameter (ID) tube;the Cormack grade was 3. The ETT was cut below 26 cm for unknown reasons.
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