Case 4: Occluded Reinforced (Armored) Endotracheal Tube

Abstract

An 8-year-old boy is presented for a major ear, nose, and throat (ENT) procedure. A reinforced endotracheal tube (ETT) (Mallinckrodt, St. Louis, MO) is used to secure the airway after induction of general anesthesia. Normally, these tubes are removed at the end of the procedure once the tracheostomy has been performed. In this case, however, due to surgical reasons, a tracheostomy is not done, and the patient is taken to the intensive care unit (ICU) with the reinforced ETT in place. You decide to leave the ETT in the trachea and to ventilate the child mechanically overnight because he exhibits marked head and neck edema after 10 h of surgery. The possibility of potential severe laryngeal edema makes you decide not to change the reinforced ETT with a standard ETT over a tube changer. The next morning, on awakening from the sedation, the patient bites down vigorously on the reinforced ETT. Due to the nature of the reinforced ETT, the lumen becomes completely occluded and will not re-expand. The patient cannot breathe nor can the lungs be ventilated. This results in oxygen desaturation to 80 %. Cyanosis becomes evident. The jaw can easily be opened.