Korean J Crit Care Med.  2017 Feb;32(1):70-73. 10.4266/kjccm.2016.00437.

A Reinforced Endotracheal Tube Completely Severed by a Patient Bite and Lodged in the Right Main Bronchus

• Yoon S
• Choo H
• Kim SE
• Kwon H
• Lee H

• KMID: 2371156
• DOI: http://doi.org/10.4266/kjccm.2016.00437

Abstract

Reinforced endotracheal tubes (ETTs) are designed to resist kinking or compression. However, these have a potential risk of being obstructed or severed by a patient's bite. We report a case in which a reinforced ETT was severed by tube-bite while the patient was in the prone position during an intensive care unit stay. Bronchoscopic evaluation showed that the severed distal part of the tube had lodged in the patient's right main bronchus, and it had to be surgically removed. The patency of reinforced ETTs should be carefully monitored in patients intubated in the prone position.

Keyword

airway obstruction; bronchoscopy; intubation; intratracheal; prone position

MeSH Terms

Airway Obstruction
Bronchi*
Bronchoscopy
Humans
Intensive Care Units
Intubation
Patient Rights
Prone Position

Figure

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  Figure 1. A chest anteroposterior radiograph showing the distal portion of the severed endotracheal tube lodged in the right main bronchus.

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  Figure 2. The distal portion of the endotracheal tube is completely severed by the patient’s bite.

Reference

References

1. Haas CF, Eakin RM, Konkle MA, Blank R. Endotracheal tubes: old and new. Respir Care. 2014; 59:933–52. discussion 952-5.

2. Mercanoglu E, Topuz D, Kaya N. The dissection of reinforced endotracheal tube internal wall causing intraoperative airway obstruction under general anesthesia: case report. Braz J Anesthesiol. 2013; 63:372–4.

3. Brusco L Jr, Weissman C. Pharyngeal obstruction of a reinforced orotracheal tube. Anesth Analg. 1993; 76:653–4.

4. Ball JE, Platt S. Obstruction of a reinforced oral tracheal tube. Br J Anaesth. 2010; 105:699–700.

5. Populaire C, Robard S, Souron R. An armoured endotracheal tube obstruction in a child. Can J Anaesth. 1989; 36(3 Pt 1):331–2.

6. Santos IA, Oliveira CA, Ferreira L. Life-threatening ventilatory obstruction due to a defective tracheal tube during spinal surgery in the prone position. Anesthesiology. 2005; 103:214–5. discussion 215.

7. Azim A, Matreja P, Pandey C. Desaturation with flexometallic endotracheal tube during lumbar spine surgery-a case report. Indian J Anaesth. 2003; 47:48–9.

8. Balakrishna P, Shetty A, Bhat G, Raveendra U. Ventilatory obstruction from kinked armoured tube. Indian J Anaesth. 2010; 54:355–6.

9. Chalkeidis O, Kalakonas A, Chaidutis C, Chotoumanidis C. Endotracheal tube cutting during neurosurgical operation. Eur J Anaesthesiol. 2009; 26:533–4.