Case 43: Occlusion of an Endotracheal Tube in a Neonate

Abstract

A prematurely born boy of 28 weeks’ gestation (780 g) with respiratory distress is admitted to your neonatal intensive care unit (NICU). Routine ventilatory treatment is given with good result. On the third day, shortly after endotracheal suctioning, his respiratory parameters deteriorate. The peak pressures are seen to increase significantly, and hand ventilation confirms decreased compliance. You pass a suction catheter down the endotracheal tube (ETT), but this time you note an obstruction at the distal end of the ETT. A chest X-ray confirms the correct placement of the ETT but also shows a foreign object extending from the distal part of the ETT into the right main bronchus. Your thoracic surgical colleague says it is impossible to remove the object from the ETT with a fiber-optic bronchoscope. You know that you must remove the object.