Which of the following is an intubation complication?

• A. Laryngeal Edema
• B. Tracheal Rupture
• C. Right Mainstem Intubation
• D. Esophageal Intubation

Answer: (D)

Placing an endotracheal tube aims to thread the tube into the trachea to secure the airway. When that placement goes wrong—that is, the tube ends up in the esophagus instead of the trachea—it creates an immediate, potentially life‑threatening complication. Esophageal intubation means there is no ventilation of the lungs, at least not through the intended airway, and rapid recognition and correction are essential. Signs include lack of reliable ventilation despite chest movement or bagging, abdominal insufflation, and, most reliably, absent end-tidal CO2 with capnography.

Other options are real airway-related problems, but they reflect different mechanisms. Laryngeal edema is swelling from mucosal irritation or trauma, often contributing to airway obstruction later or after extubation. Tracheal rupture is a rare but serious injury from instrumentation or cuff overinflation. Right mainstem intubation occurs when the tube is advanced too far and goes into the right main bronchus, causing unequal ventilation. These can occur with intubation, but esophageal misplacement stands out as the quintessential immediate complication of the intubation process itself because it represents a failure to access the correct airway and requires urgent correction.