Difficult extubation due to failure of an endotracheal tube cuff deflation

Suman, Sourabh; Ganjoo, Pragati; Tandon, Monica

doi:10.4103/0970-9185.76683

Cited by 18 publications

(5 citation statements)

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“…1) A cuff that did not deflate due to kinking in the pilot tube, caused by tapes securing the tracheal tube to the patient's face, was resolved in different ways. These included removing the tapes causing the kink [ 3 ], extubating with the cuff still inflated [ 4 ], cutting the pilot line [ 5 ], aspirating the pilot line distally to the obstruction with a 16G needle [ 6 ], directly puncturing the cuff with a 22G spinal needle through the vocal cords [ 7 ], and puncturing the cuff through the cricoid membrane [ 8 ]. 2) Abnormal folds in a fully deflated cuff, preventing tracheal tube removal in a narrow airway, were addressed by subtly insufflating the cuff to undo the folds and facilitate tube removal [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Challenges in Extubation: A Case of a Non-removable Tracheal Tube Following Surgery

Silva,

Carvalho,

Tarroso

et al. 2024

Cureus

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This report details a challenging case of difficult extubation due to a lodged tracheal tube following surgery, presenting an unexpected and complex clinical situation. An inspection of the airway using videolaryngoscopy revealed an over-inflated cuff beneath the vocal cords. Initial efforts to deflate the cuff with various methods were unsuccessful. The situation was ultimately resolved through the intervention of an otolaryngology surgeon. This case not only reviews various mechanisms of difficult endotracheal tube removal reported in the literature, but also underscores the potential for serious complications and highlights the critical role of multidisciplinary collaboration in managing extubation challenges. Additionally, our manuscript discusses alternative strategies that can be employed in scenarios where an otolaryngology surgeon is not available, offering practical guidance for anesthesiologists confronted with similar situations.

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Section: Discussionmentioning

confidence: 99%

Challenges in Extubation: A Case of a Non-removable Tracheal Tube Following Surgery

Silva,

Carvalho,

Tarroso

et al. 2024

Cureus

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“…This case demonstrates an unusual reason for difficult tracheal tube removal. The most common cause is an inability to deflate the cuff, either due to a manufacturing fault in the pilot tubing or valve mechanism, or inadvertent kinking and occlusion of the pilot tubing [1]. It highlights the importance of refraining from forcible removal of a tracheal tube, which can cause laryngeal trauma, vocal cord injury or oedema and arytenoid cartilage dislocation [2].…”

Section: Discussionmentioning

confidence: 99%

Surgical tracheostomy in a patient with a stuck tracheal tube in situ

Cole

Conway

2023

Anaesthesia Reports

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The inability to extubate a patient's trachea due to a mechanical complication is rarely encountered in clinical practice. The risks of attempting to remove a stuck tracheal tube include laryngeal trauma, vocal cord injury and arytenoid dislocation, all of which have significant implications. Here, we report the case of a patient who was admitted to the intensive care unit for mechanical ventilation following liver transplant surgery. Her trachea was initially extubated on the second postoperative day, but she required further mechanical ventilation the following day and her trachea was re-intubated. Five days later, she was deemed suitable for tracheal extubation, but the formation of granulation tissue around the tracheal tube prevented its removal. A multidisciplinary decision-making approach was taken when deciding to site a surgical tracheostomy. A flexible bronchoscope was used as an aid for safe placement. This facilitated safe extrication of the tracheal tube, which was freed by gentle manipulation both proximally and distally. We suspect that tracheal tube size may have been a factor in the development of the granulation tissue in this case. It is important to consider tracheal tube size in all patients, particularly if they require tracheal re-intubation or are likely to require mechanical ventilation for a prolonged period.

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“…In people, complications related to extubation include ETTs inadvertently fixated during the procedure, inability to deflate the cuff, cuff folding, anatomical abnormalities or airway oedema preventing the tube removal (Bergman & Sprung, 2003; Lall, 1980; Lang et al, 1989; Probert & Hardman, 2003; Searl & Passey, 2000; Sprung et al, 1991; Suman et al, 2011; Yazbek‐Karam et al, 2009; Zhang et al, 2021). A rare but fatal outcome has been reported after a rupture of a transfixed pulmonary artery during extubation (Dryden, 1977).…”

Section: Introductionmentioning

confidence: 99%

Extubation failure and surgical removal of a lodged endotracheal tube in a Welsh Mountain Pony

Libera,

Barnes,

Senior

2023

Equine Veterinary Education

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SummaryComplications related to endotracheal intubation are well recognised in both human and veterinary medicine; however, difficult extubation is rare and is typically related to accidental physical fixation, inability to deflate the cuff, anatomical abnormalities or an inappropriate tube. In this case report we describe an unexpected failure to extubate where tracheotomy was required to facilitate the removal of the endotracheal tube in an adult pony.

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Difficult extubation due to failure of an endotracheal tube cuff deflation

Cited by 18 publications

References 0 publications

Challenges in Extubation: A Case of a Non-removable Tracheal Tube Following Surgery

Challenges in Extubation: A Case of a Non-removable Tracheal Tube Following Surgery

Surgical tracheostomy in a patient with a stuck tracheal tube in situ

Extubation failure and surgical removal of a lodged endotracheal tube in a Welsh Mountain Pony

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