Prolonged use of an endotracheal tube changer in a pediatric patient with a potentially compromised airway

A 14-year-old obese male patient presented following a motor vehicle accident with multiple injuries and respiratory failure requiring endotracheal intubation and mechanical ventilation. Because of potential problems with a difficult airway, an endotracheal tube changer was used at the time of extubation and left in place for a prolonged period of time. Leaving the tube changer in place maintained access to the airway. Additionally, the manipulation of the tube changer was used to stimulate the cough reflex.