Endotracheal tube inflation tubing defect: an unusual cause of intraoperative volume leak
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LETTER TO THE EDITOR
Endotracheal tube inflation tubing defect: an unusual cause of intraoperative volume leak Abhyuday Kumar1 · Amarjeet Kumar2 · Neeraj Kumar2 · Ajeet Kumar3 Received: 13 July 2020 / Accepted: 12 October 2020 © Springer Nature B.V. 2020
Abstract Loss of endotracheal cuff pressure can lead to airway compromise and loss of volume delivery in mechanical ventilation requiring immediate intervention. A 40 years old male posted for bilateral interpositional arthroplasty was intubated nasally with 7.5 mm flexometallic endotracheal tube. In the intraoperative period airway leak was detected due to loss of cuff pressure even after repeated attempt of cuff inflation. After changing endotracheal tube, leak was detected from the inflation tubing distal to the cuff, which was apparent only when cuff pressure was increased above 30 cm of H2O. Keywords Endotracheal tube · Cuff · Leak · Inflation tubing · Defect To the Editor, Endotracheal cuff pressure is ideally maintained between safe margins of 20 to 30 cm of H 2O. Loss of endotracheal cuff pressure can compromise secure airway and increase the chance of aspiration. Airway leak can vary from a mere annoying bubbling sound to a life-threatening respiratory compromise requiring immediate intervention. We report a case where airway leak was detected intraoperatively due to inflation tubing defect that was missed out during the preanaesthetic equipment check. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10877-020-00607-7) contains supplementary material, which is available to authorized users. * Abhyuday Kumar [email protected] Amarjeet Kumar [email protected] Neeraj Kumar [email protected] Ajeet Kumar [email protected] 1
Department of Anesthesiology, AIIMS Patna, Room No. 15, OPD Block, Phulwarisarif, Patna, Bihar, India
2
Department of Trauma & Emergency, AIIMS Patna, Patna, India
3
Department of Anesthesiology, AIIMS Patna, Patna, India
A 40 years old male was posted for bilateral interpositional arthroplasty and fixation of left mandibular parasymphysis region under general anesthesia. After induction, trachea was intubated with 7.5 mm (ID) flexometallic endotracheal tube (ETT) (Rusch, Teleflex Medical, Germany) nasally with direct laryngoscopy. Cuff pressure was measured with manometer and clinically no audible leak was found on suprasternal auscultation at a pressure of 25 cm of H2O. Patient was then put on volume control ventilation with tidal volume of 450 ml, respiratory rate 12/minute and I:E ratio of 1:2. Patient was positioned with neck extension and neck rotated to right side. Ten minutes after positioning, it was noted that there is around 30% leak in expired tidal volume. Position of the endotracheal tube was checked which was found to be right and bilateral air entry was equal. Inflating the cuff of the endotracheal tube decreased the leak and patient was again positioned for surgery. After few minutes again leak was apparent. Provisional diagnosis of endotr
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