aka Anaesthetic Addler 002.1
Here’s a puzzle for all you Airway Sherlock’s to ponder:
An ICU patient’s endotracheal tube was deemed to be sitting too low in the trachea based on a post-intubation chest x-ray. The cuff was deflated and the ETT was withdrawn 2 cm, so that the tip was correctly positioned in the mid-trachea. The cuff was reinflated.
Subsequently, when the cuff pressure was checked, the manometer measured a pressure of zero. Another manometer was used and the same result obtained – zero.
No air leak could be heard on auscultating the neck while the patient was bagged, and there was no air leak detected by the ventilator. The pilot balloon of the endotracheal tube was still inflated and felt firm. The patient remained stable. The manometers worked perfectly when used on other patients.
What has happened?
… and yes, as always, the first correct answer will render the answerer worth of F.UCEM status!
About Chris Nickson
ETT pilot tube or valve fault. Similar issue as occasionally seen in IDC’s. Could the cuff subsequently be deflated?
Thats my thought as well, damage to the one way valve so air can’t escape any longer
Possible cause:
Manometer not connected properly to the pilot balloon when measuring the pressure (therefore measuring atmospheric pressure instead of cuff pressure)?
due to:
- not being screwed in properly
- debris around connection site not allowing proper connection
Several things come to mind:
1. Valve malfunction or connection problem (not seated, foreign substance interference)with the inflation valve.
2. Staff are (somehow) using the above-ballon suction port, rather than the balloon-inflation port to measure pressure.
3. Tracheal swelling, enough to negate any air-leak being heard. But, this shouldn’t affect the pilot balloon.
Lots of good thoughts -- still no answers describing what actually happened…
C
Pilot balloon line stuck in the tube securing device
You da man!
Chris
Did they perchance deflate the cuff with a saline flush?
Could it have been due to a high riding cuff resulting in the manometer with 0 mmHg pressure ?
there may be chance of tracheomalacia or tracheal collapse
Sounds like the practitioner forgot to open the stopcock.