|Home | About | Journals | Submit | Contact Us | Français|
Leaking endotracheal tube cuffs are common problems in intensive care units. We report a case wherein the inflation tube was damaged by the adhesive plaster used for tube fixation and resulted in leaking endotracheal tube cuff. We also give some suggestions regarding the tube fixation and some remedial measures for damaged inflation system.
A well-secured endotracheal tube (ETT) is essential for safe anesthesia. If ETT is not well secured, there is a danger of either unplanned extubation or advancement of the tube deeper into the trachea. However, improper tube fixation can damage the inflation system and can be a rare cause of leaky ETT cuff, making maintenance of adequate ventilation difficult. We encountered a case wherein the inflation tube was damaged by the adhesive plaster used for tube fixation.
A 33-year-old male patient with the history of motor vehicular accident was brought in the emergency department. On primary survey, his airway was compromised and oxygen saturation with O2 by face mask was 78%. His Glasgow goma score was 5; hence to protect the airway, the patient was intubated with 8.0 mm ETT by a resident doctor. The tube was secured with Durapore adhesive plaster at 21 cm at the level of incisors. The adhesive plaster was encircled thrice around the tube; once including the tube and twice excluding the inflation tube. The patient was further investigated and CT scan head revealed a large extradural hematoma with midline shift. The patient was posted for surgical evacuation of extradural hematoma. In operation theatre, it was observed that the ETT cuff was leaking. After checking the exposed part of inflation system, which was intact, it was decided to change the tube. On removing the adhesive plaster, we observed that there was a cut in the inflation tube at the level of entry in ETT. The trachea was reintubated with 8.0 mm ETT. The difficult airway kit, that is, multiple blades, small sized tubes, McCoy laryngoscope, laryngeal mask airway, and tracheostomy kit were kept ready in case of any difficulty in reintubation. On close examination of ETT, we concluded that overextension of the inflation tube lead to the cut in the tubing. Three turns of adhesive plaster once including and twice excluding the inflation tube might be responsible for avulsion of the inflation tube from the tracheal tube. Rest of surgery was uneventful. The patient was on ventilator for 4 days. He was discharged on day 12 after surgery with mild cognitive dysfunction.
A leaking endotracheal cuff may make maintenance of adequate ventilation difficult, fail to protect against aspiration, and make surgery difficult. A defect in the cuff or the inflation system, i.e., inflation tube, pilot balloon, or the valve may be the reasons of leaking cuff. When one is faced with this problem, the best solution is to have the patient reintubated as soon as possible. This is especially true if the patient is mechanically ventilated, because little tidal volume will be delivered while the cuff is unpressurised and deflated. However, extubation, manual ventilation, and reintubation should be avoided, if possible, in certain situations:
We would like to give some suggestions regarding tube fixation and some temporary remedial measures in case of leaky cuff if reintubation is not feasible:
We have reported a case of leaking endotracheal cuff due to faulty fixation of tube. Securing the tube is a basic maneuver, yet if done improperly can lead to disasters. The basic principle of traction and countertraction should be followed for ETT fixation and multiple overlaps of adhesive plaster should be avoided. In case of difficult intubation or situations wherein reintubation is not possible, simple techniques described earlier can be used to reinflate the cuff.
Source of Support: Nil
Conflict of Interest: None declared.