To correct right mainstem intubation, what should be done?

In the scenario of right mainstem intubation, where the endotracheal tube is inadvertently placed into the right main bronchus instead of the trachea, the correct action is to deflate the cuff and pull back slightly. This approach allows for re-positioning the tube back toward the midline, ideally into the trachea, where it can properly ventilate both lungs.

When the cuff is deflated, it reduces the pressure and allows the tube to move slightly back while providing that little bit of space for adjustment. This is a critical intervention because accurate placement of the endotracheal tube is necessary to ensure that both lungs receive adequate ventilation and oxygenation.

Advancing the tube deeper may further exacerbate the problem by pushing it even further into the bronchus, and removing the tube completely can lead to airway loss, which is dangerous, especially in an already compromised patient. Immediate re-intubation might also be considered, but it’s usually more effective to adjust the current position of the tube rather than introducing a new tube without confirming proper placement.