Options for Intraoperative Repair of a Cut Pilot Balloon on the Endotracheal Tube

Abstract

Severing of the pilot balloon of an endotracheal tube (ETT) results in cuff deflation and may lead to complications including inadequate patient ventilation, increased risk of aspiration and infection, and operating room air pollution with anesthetic gases. In situations where ETT exchange or reintubation may pose a significant risk to the patient, temporary repair of the severed cuff tubing can be helpful until it is safe to address the problem with replacing the ETT. Simple and effective repair methods can be achieved using readily available materials in the operating room, including intravenous cannulas, hypodermic syringes, and epidural clamp connectors. However, choosing which technique or method depends mainly on personal preference, equipment availability, and provider comfort and experience. We present a 12-year-old adolescent who presented for anesthetic care for extensive burn injury. During removal of the dressing around the head and face, the tubing of the pilot balloon of the ETT was inadvertently cut. Options for dealing with such problems are discussed, including techniques to allow for temporary repair and re-inflation of the deflated cuff.

Management of endotracheal tube air leak—a simple yet an effective manoeuver

“…Thus, the use of a three-way stopcock with the intravenous cannula has been suggested. 6 The intracuff pressure can be monitored and kept at less than 27 mmHg.…”

“…In the present case, intravenous cannula was opted for because it is available in every health care facility. The use of IV cannula has been used and tested 4,6 A limitation of this method is the possibility of damage to the pilot line during insertion of the needle. Because of the emergency situation, the risk of such a hazard is substantially increased.…”

Efficacy of using an intravenous catheter to repair damaged expansion lines of endotracheal tubes and laryngeal masks

“…Owusu et al described the use of a venous catheter for connecting the end of a cut-off expansion line. When measuring the balloon pressure, it is necessary to use the three-way valve [ 32 ]. Hills et al .…”

Unforeseen complications: towel clip-induced pilot balloon injury resulting in endotracheal tube cuff leak during surgery

“…The shared surgical field further complicates access. In instances where tracheal reintubation or tube exchange present challenges, preserving the pilot balloon cuff to prevent cuff deflation can be implemented until the procedure concludes [ 1 ]. Various methods for averting such mishaps have been documented in the literature.…”