Airway obstruction by a folding metal rod within a reinforced oral tracheal tube: Case report

Claudio Luciano Franck, Samuel da Rosa Sousa,  Guilherme Voltolini, Raquel Jardim de Melo, Isabela Picolotto Moraes

Cite

Franck CL, Sousa SR, Voltolini G, Voltolini G, Mello RJ, Moraes IP. Airway obstruction by a folding metal rod within a Reinforced Oral tracheal Tube. Case Report. J Mech Vent 2022; 3(2):83-86.

Abstract

The Reinforced Orotracheal Tube (ROT) is an airway device for intubation that allows invasive ventilation during general anesthesia. The ROT differs from a Conventional Endotracheal Tube (CET) by the presence of a stainless-steel spiral, which strengthens the wall and hinders collapse.

The ROT can be used when there is a risk of obstructing the flow of gases through compression or elbowing of the endotracheal tube, during orofacial surgical procedures, neurosurgery or in non-supine surgical positions under deep general anesthesia. The metallic spiral, which reinforces the lumen of this endotracheal tube, is subject to damage and deformities that can compromise the permeability of its lumen.

The ROT should be used only during the surgical procedure under deep general anesthesia. If there is a need for the permanence of orotracheal intubation in the postoperative period of patients referred to the intensive care unit, the ROT should be replaced by the polyvinyl chloride CET, given the risk of damage to the ROT due to bites with fracture of the metal rod and obstruction by folding, as in this case, which will be reported below.

The rarity of similar reports in the literature and the severity of obstruction of an endotracheal tube causing severe hypoxemic disorders, guided the objective of this case report, which aims to guide preventive and resolving measures, in addition to including to the list of diagnoses of causes of acute obstructions of an endotracheal tube.

Keywords

Airway obstruction; Armoured tube, intubation, mechanical ventilation

References

1. Mallampati SR, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 1985; 32(4):429-434.
https://doi.org/10.1007/BF03011357
PMid:4027773 
2. Gurumurthy T, Rammurthy K, Mahmood LS, et al. An unusual complication in reusing the reinforced tube. Revista de Anestesiologia, Farmacologia Clínica 2012; 28(4):528-530.
https://doi.org/10.4103/0970-9185.101950
PMid:23225942 PMCid:PMC3511959 
3. Hosseinzadeh N, Samadi S, Javid MJ, et al. Impending complete airway obstruction from a reinforced orotracheal tube: A Case Report. Acta Med Iran 2015;53(9):590-592. 
4. Shah SB, Bhargava AK, Goyal P. Armored tubes: An unusual chink in armor. Indian Anaesth Forum 2016; 17:65-66.
https://doi.org/10.4103/0973-0311.195968 
5. Malhotra D, Rafiq M, Qazi S, et al. Ventilatory obstruction with spiral embedded tube – Are they as safe? Indian Journal of Anaesthesia 2007; 51(5):432-433. 
6. Yoon S, Choo H, Kim SE, et al. A Reinforced Endotracheal tube completely severed by a patient bite and lodged in the right main bronchus. Korean J Crit Care Med 2017; 32(1):70-73.
https://doi.org/10.4266/kjccm.2016.00437
PMid:31723618 PMCid:PMC6786742 
7. Ball JE, Platt S. Obstruction of a reinforced oral tracheal tube. Br J Anaesth 2010; 105:699- 700.
https://doi.org/10.1093/bja/aeq289
PMid:20952432 
8. Jain R, Sethi N, Sood J. Loss of integrity of a reinforced endotracheal tube by patient bite. Indian Journal of Anesthesia 2013, 57(4): 424.
https://doi.org/10.4103/0019-5049.118520
PMid:24163469 PMCid:PMC3800347 
9.Balakrishna P, Shetty A, Bhat G, et al. Ventilation obstruction of folded armored tubes. Indian J Anaesth 2010; 54: 355-356.
https://doi.org/10.4103/0019-5049.68380
PMid:20882187 PMCid:PMC2943715 
10.Vijayakumar V, Ganesamoorthi A. Armored endotracheal tube: Concerns in intensive care unit. Indian J Crit Care Med 2017; 21(1):60-61.
https://doi.org/10.4103/0972-5229.198331
PMid:28197056 PMCid:PMC5278596 
11.Mendonça FT, Martins LD, Gazzi R, et al. Lumen dissection of wire endotracheal tube during general anesthesia: case report. Rev Bras Anestesiol 2017; 67(6):659-662.
https://doi.org/10.1016/j.bjan.2015.09.010
PMid:26422666 
12.Mercanoglu E, Topuz D, Kaya N. Dissection of the internal wall of the reinforced endotracheal tube causing intraoperative airway obstruction under general anesthesia: case report. Rev Bras Anesthesiol 2013; 63(4): 372-374.
https://doi.org/10.1016/j.bjan.2012.07.008
PMid:23931255 
13.Wadhwa R, Dhakate G, Chilkoti G. Reinforced endotracheal tube: A life threatening experience in intensive care unit. Saudi Journal of Anaesthesia 2013; 7:358-3599.
https://doi.org/10.4103/1658-354X.115348
PMid:24015150 PMCid:PMC3757820