Case 2: Is the Patient Extubated?
- 114 Downloads
An otherwise healthy 48-year-old man is being ventilated in the ICU following major abdominal surgery. You are called urgently because the ICU nurse informs you that she can hear air escaping from the patient’s mouth. She is concerned that the patient may have become extubated. His vital signs are HR 90, BP 140/90, and oxygen saturation 96% on FiO2 of 100%. You arrive and find him somewhat sedated but agitated. You talk to him but he does not answer back despite trying to do so. The nurse tells you that the patient was previously saturating at 92–94% on 40% FiO2. The ventilator is alarming. The endotracheal tube (ETT) (#8) is taped at 22 cm. A universal bite block (B&B Medical Technologies, Vista, CA 92083) is seen in his mouth (Fig. 2.1). The bite block consists of a 5-cm-long hollow plastic tube that has a 0.5-cm-long longitudinal opening. This opening stretches from top to bottom going through the whole length of the bite block. An anchoring device (a plastic strap) is available on the bite block so as to attach it to the ETT. An audible leak is heard. You detach him from the ventilator, and with an Ambu bag, you confirm that he has got bilateral air entry although they are distant. Air/bubbles can be heard/seen coming from his mouth. You decide to blow up the ETT cuff, as there must be a leak due to lack of air in the ETT cuff. However, the cuff on the pilot tubing is already blown up and feels very tight. You push some more air into the pilot tubing. No improvement is seen and you can still hear a leak at the mouth. The ventilator continues to alarm. What will you do and what is the cause of your dilemma?