Airway exchange catheter is a valuable tool where an airway is anticipated to be difficult to reintubate. We report a case of subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, and pneumothorax after extubation using an exchange catheter. There was an iatrogenic tracheal tear during airway management that filled the connected spaces with oxygen insufflation through the catheter. The management was prompt with reintubation and drainage of pneumothorax using intercostal cannula connected to underwater seal constructed from available equipment. The patient was ventilated for 2 days and then extubated without complications. Airway exchange catheter should be used cautiously with a low initial gas flow during extubation.
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