Cuff herniation as the cause of right main bronchus obstruction following tracheostomy

Kumar, Amarjeet; Kumar, Ajeet; Mithun, R; Pattanayak, Arunima

doi:10.1016/j.jclinane.2021.110188

Cited by 1 publication

(2 citation statements)

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“…Secondly, in all cases, the cuff problem manifested as difficult ventilation, characterised by reduced gas flow and increased respiratory effort, or low delivered tidal volume despite high peak inspiratory pressures during IPPV. This agrees with previous observations reported in human (Barker & Stotz, 2013;Bar-Lavie et al, 1995;Davis et al, 2011;Hofstetter et al, 2010;Justiz & Mayhew, 2007;Kumar et al, 2021) and veterinary (Bergadano et al, 2004;Richardson & McMillan, 2017) literature on ETT obstruction. The sequelae can be severe, as severe hypercapnia and hypoxaemia can develop in minutes if critical hypoventilation is not promptly recognised and the problem resolved.…”

Section: Discussionsupporting

confidence: 93%

“…This may be either due to pressure‐induced luminal collapse of ETTs, or due to herniation of the cuff, which then obstructs the ETT outflow including the Murphy eye. There are several case reports in human medicine describing ETT obstruction due to cuff overinflation (Davis et al, 2011; Hofstetter et al, 2010; Zenga et al, 2018) and cuff herniation (Barker & Stotz, 2013; Bar‐Lavie et al, 1995; Kumar et al, 2021), but only two reports of cuff herniation in veterinary medicine (Bergadano et al, 2004; Richardson & McMillan, 2017). The possibility of ETT obstruction secondary to cuff overinflation may be an underrecognised phenomenon in equine practice, but it can be life‐threatening if not identified and resolved timely.…”

Section: Introductionmentioning

confidence: 99%

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Endotracheal tube obstruction due to cuff overinflation or cuff herniation in small equids: A case series

Veen

Grauw

2023

Equine Veterinary Education

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Summary Adequate inflation of the endotracheal tube (ETT) cuff is important to avoid leakage of anaesthetic gases or aspiration of gastric contents and to allow positive pressure ventilation. However, overinflation or herniation of the cuff can cause tracheal mucosal damage and in rare cases even obstruction of the ETT. ETT obstruction due to the cuff itself may be an underrecognised phenomenon in equine practice and we aim to create awareness with this retrospective case series (n = 3). Cases identified between 2014 and 2021 with (partial) ETT obstruction due to cuff overinflation or cuff herniation at the Utrecht University Equine Clinic were selected. Anaesthesia records were examined and presented. Two cases occurred in foals and one in a pony. In each case, high airway pressure was encountered and no or minimal thoracic excursions were visible. In all three cases, cuff deflation led to immediate normalisation of ventilation parameters. When presented with an intubated patient that is difficult to ventilate and high airway pressures exist, ETT cuff overinflation or herniation should be considered as a possible cause; rapid cuff deflation should be included in algorithms for management of ventilation failure due to suspected airway obstruction.

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