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Table of Contents
LETTER TO EDITOR
Year : 2015  |  Volume : 31  |  Issue : 4  |  Page : 568-569

Unusual airway foreign body: Vigilance is the price of safety


Department of Anaesthesia and Critical Care, Medanta - The Medicity, Gurgaon, Haryana, India

Date of Web Publication5-Nov-2015

Correspondence Address:
Preety Mittal Roy
Department of Anaesthesia and Critical Care, Medanta - The Medicity, Sector 49, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.169099

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How to cite this article:
Barde S, Roy PM, Khanna S, Mehta Y. Unusual airway foreign body: Vigilance is the price of safety . J Anaesthesiol Clin Pharmacol 2015;31:568-9

How to cite this URL:
Barde S, Roy PM, Khanna S, Mehta Y. Unusual airway foreign body: Vigilance is the price of safety . J Anaesthesiol Clin Pharmacol [serial online] 2015 [cited 2020 Sep 25];31:568-9. Available from: http://www.joacp.org/text.asp?2015/31/4/568/169099

Sir,

Tracheobronchial foreign body aspiration is a serious medical problem, with clinical manifestations ranging from acute asphyxiation to insidious lung damage. We report a case, where a portion of the cuff of the endotracheal tube was recovered from the trachea.

A 59-year-old male patient in the ward complained of severe respiratory distress and inability to lie down supine.

Patient was admitted in our hospital 5 days ago with the diagnosis of fluid overload and chest infection. Patient was managed with antibiotics, fluid restriction, hemodialysis, and noninvasive mechanical ventilation. Later, the patient was intubated and mechanically ventilated. Patient improved in the next 53 h and was extubated.

Patient had mild respiratory distress in the immediate post extubation period which responded to nebulization and chest physiotherapy. Over the period of next 2 days, the patient's condition worsened with the intensity of respiratory difficulty becoming so severe that the patient was unable to lie down supine and there was a need for supplemental oxygen to maintain a saturation of 95%. On examination, the patient was having biphasic stridor but no cyanosis. Bilateral wheezing was noted. A provisional diagnosis of tracheal stenosis was made from the X-ray, soft tissue of the neck showed the increased soft tissue density below the vocal cords. To further evaluate the patient, contrast-enhanced computed tomography at the neck was done which showed the circumferential thickening of trachea in subglottic region (approximately 3 cm) and a tubular object (foreign body approximately 3 cm) was seen lying in trachea 4.5 cm above the carina [Figure 1].
Figure 1: Tubular foreign body in the trachea

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The plan was made for rigid bronchoscopy and the foreign body removal. The consent was also taken for tracheostomy, if the need arises. Anesthesia was induced, and general anesthesia maintained using fentanyl, propofol, and atracurium boluses and infusion respectively, and apnoeic diffusion oxygenation followed by intermittent positive pressure ventilation.

On bronchoscopy, slough covering the degenerative foreign body of approximately 3 cm with pericondritis, and narrowing of the trachea was found. The bilateral vocal cord and the subglottic region was normal. A supracarinal tracheal segment of approximately 5 cm was normal.

To our surprise, foreign body recovered was plastic in nature and it was concluded that it was a portion of the cuff of the endotracheal tube.

The endotracheal tube used in our hospital are PVC tubes which have a cuff of 50-80 microns in thickness. [1] The ideal cuff pressure should be in the range of 20-30 cm of water (15-22 mm of Hg). [1] The issues associated with the endotracheal cuff can range from high cuff pressure, insufficient inflation, progressive deflation, or damage to the cuff. Endotracheal cuffs can be damaged by teeth during passage or by the edge of the laryngoscope. The mechanism of cuff damage could not be explained, but we can always take measures to avoid such situations. On review of the literature, we found a few case reports, where the cuff of red rubber tube having high pressure ruptured intraoperatively. [2],[3],[4]

Hence one should inspect the endotracheal tube during extubation and document the body for its completeness. Constant vigilance is the price of safety.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Spiegel JE. Endotracheal tube cuffs: Design and function. Anesthesiology News Guide to Airway Management 2010;36:51-8.  Back to cited text no. 1
    
2.
Doyle LA, Conway CF. A hazard of cuffed endotracheal tubes. Anaesthesia 1967;22:140-1.  Back to cited text no. 2
[PUBMED]    
3.
Divekar VM. Rupture of a cuffed tube. Anaesthesia 1967;22:531.  Back to cited text no. 3
[PUBMED]    
4.
Debnath SK, Waters DJ. Leaking cuffed endotracheal tubes: Two case reports. Br J Anaesth 1968;40:807.  Back to cited text no. 4
[PUBMED]    


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