Endotracheal tube defects: Hidden causes of airway obstruction

Abstract

Manufacturing defects of endotracheal tube (ETT) are still encountered in anesthesia practice. Many such defects go unnoticed during routine inspection prior to their use. Such defects in ETT may lead to partial or complete airway obstruction in an intubated patient. We report a case of partial airway obstruction with a prepacked, single use, uncuffed ETT due to a manufacturing defect in the form of a plastic meniscus at the distal end of the tube. This case report highlights the significance of standard monitoring of ventilation and the role of a vigilant clinician in detecting such defects in avoiding critical events as can arise from the use of such defective ETTs. It also emphasizes the need for double checking ETTs prior to their use.

Endotracheal Tube Obstruction: A Manufacturing Defect

“…Endotrakeal tüplerdeki imalat hataları sonucu gelişen havayolu obstrüksiyonların sunulduğu pek çok olgu sunumu yayımlanmıştır (1,4,(10)(11)(12)(13). Sunduğumuz olguda ise entü-basyon sonrası pik hava yolu basıncının yüksek olması, SpO 2 değerinin düşmeye, ETCO 2 'nin ise yükselmeye başlaması ve ekspire edilen hava miktarının düşük olması tüp içerisinde bir tıkaç ya da sekresyon ihtimalini aklımıza getirdi.…”

“…Endotrakeal entübasyon yapılmış hastalarda endotrakeal tüpteki defektlere bağlı olarak ventilasyon zorluğu oluşabilir (1). ET'ü kullanmadan önce görsel olarak incelemeler yapılsa bile bazı üretim hataları fark edilemeyebilmektedir (2).…”

Two different endotracheal tube manufacturing defects

“…If there is no problem in the system, the ET tube should be checked. Herniation of the ET cuff, kinking of the tube, intraluminal plastic film or obstruction by meniscus and obliteration of the ETT connector are the known manufacturing defects that can result in difficulty in ventilation [1,3,[6][7][8][9]. In case 1, there was a narrowing of the tube connector making ventilation difficult.…”

“…In preoperative preparation period, ET tube, particulary its cuff and lumen, should be checked. If manufacturing defect is not noticed in preoperative period, it can result in serious airway obstructions [1,3,[6][7][8][9] or air leakage during anesthesia [10][11][12]. If manufacturing defect of ET tube is suspected, then the equipment must be immediately changed.…”

A Case of Difficult Ventilation

“…The main causes of difficult ventilation include disturbances in anesthetic gas flow, obstructions in the breathing-circulation system, decreased pulmonary compliance, severe acute bronchospasm, tension pneumothorax and endobronchial mass lesions [1]. Secretions, cuff herniation, faults in manufactured airway equipment and kinking of the tube might also cause obstructions in the breathing-circulation systems [2].…”