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

Using an endotracheal tube that is too large for a child can lead to tracheal necrosis due to the excessive pressure exerted on the airway walls. The increased diameter of the tube can cause trauma to the delicate tracheal tissues, particularly when the cuff is inflated. This excessive pressure can reduce blood flow to the area, leading to ischemia and ultimately necrosis of the tracheal tissue.

In the context of pediatric patients, where the trachea is more susceptible to injury, it's crucial to select the appropriate size of the endotracheal tube to minimize the risk of complications like tracheal necrosis. Proper sizing not only promotes adequate airflow but also protects the integrity of the airway structures.