What complication should the neonatal/pediatric specialist anticipate when using an endotracheal tube that is too large for a child?

The anticipated complication of using an endotracheal tube that is too large for a child is tracheal necrosis. When an endotracheal tube is oversized for a patient's airway, it can lead to excessive pressure against the tracheal walls. This constant pressure can compromise blood flow to the trachea, resulting in ischemia and, eventually, tissue necrosis.

Tracheal necrosis can result from prolonged contact with the tube's cuff or the tube itself, especially if changes in pressure or movement irritate the tracheal lining. Using a properly sized endotracheal tube is critical to maintaining airway patency and minimizing trauma to the delicate structures of the airway.

Other potential complications of an oversized endotracheal tube, such as increased airway resistance and, although significant, vocal cord damage, tend not to be as immediately severe as tracheal necrosis. Hence, the risk of tracheal necrosis is a primary concern when evaluating the suitability of an endotracheal tube size.