A Case of Death Caused by Tracheal Tube Aspiration

Abstract

Introduction:Airway management, especially outside the operating room, needs meticulous observation in order to avoid certain risks, such as; endotracheal tube (ETT) disloca­tion, esophageal intubation, and unwanted extubation. ETT or tracheostomy dislocation is responsible for one-half of death or brain damage cases in the ICU. Despite appropri­ate fixation of an ETT, the previously mentioned compli­cations can still occur . A broken ETT and consequent airway obstruction may lead to lethal complications.Case Presentation:We report a case of death caused by tracheal tube aspiration, where it was located distal to the vocal cords, with a part of it entering the right bronchus and the mediastinum, after tearing the right bronchus.Discussion:The vigilance and experience of medical personnel in the ICU, appropriate IV sedation, and using a bite block are the best ways to prevent mortality caused by aspiration of an ETT in all intubated patients.

Aspiration of severed tracheal tube: An anesthesiologist's nightmare

“…[ 4 ] The importance of chest X-ray, computed tomography scan, and bronchoscopy during the management of aspirated TT has been discussed previously in few case reports. [ 2 3 5 ] However, in our case, the patient's condition precluded radiological evaluation. There are even reports leading to death following aspiration of tube.…”

“…There are even reports leading to death following aspiration of tube. [ 2 ] This report highlights the fact that the bite block used to prevent injury to TT can be a cause of fragmentation of TT, and there is always a possibility of broken TT aspiration in patients with poor cough reflex, especially in cervical spine injuries. Hence, a high index of suspicion is warranted in cases where the patients’ cough reflex is poor.…”

“…There are very few reports of TT aspiration in the available literature. [ 2 3 4 5 ] In one report, following an inability to remove the aspirated TT, the authors re-intubated the patient's trachea with a smaller TT through the larger aspirated TT. [ 3 ] In another report, in a child, the aspirated TT was removed with the help of Magill forceps.…”

Design of assessment tool for unplanned endotracheal extubation of artificial airway patients

“…Once lacking of effective heating and humidifying, thick sputum increases the opportunity of blocking the tube. Patients cannot be ventilated with a manual resuscitator and in whom suction cannot be performed due to a blockaged tracheal tube; they cannot be resuscitated, and airway obstruction can occur, leading lethal complications (Mirkheshti et al, 2014). Blocked tubes contribute to one-third of all airway accidents, and they are often blocked by thick secretions; most patients with blocked tubes require reintubation (Kapadia et al, 2014).…”

Management of endotracheal tube breakage during extubation in a lion (Panthera leo)

“…[3][4][5] Although rare, adverse events such as ETT breakage, ingestion and aspiration had been reported in various domestic animals including dogs, [6][7][8][9][10] cats, 11 horses, 12 sheep 13 and rabbits, 14 and in people. 15,16 Complications involving the use of ETT in zoo animals have not been reported.…”