The Science Journal of the American Association for Respiratory Care

2007 OPEN FORUM Abstracts

BITING-CAUSED COMPRESSION DAMAGE OF A METAL WIRE-REINFORCED SILICON ENDOTRACHEAL TUBE: A CASE REPORT

R. Hase1, J. Bard1, I. Smith2


Introduction:
Silicon endotracheal (ET) tubes often include a metal coil imbedded into the tube so the tube retains its flexibility while gaining luminal ridgidity. We identified a potential safety risk for silicon ET tubes with metal wire coils.

Case Summary: This 41 year old female was admitted via medics with decreased level of consciousness, diabetic keto-acidosis, and acute renal failure. She received fluid-resuscitation in the field prior to arrival, and quickly developed increasing supplemental oxygen requirements, then precipitously deteriorated, suffering cardiac arrest. She was successfully resuscitated but intubation required pharmacologic paralysis and use of a Bivona Aire-Cuf® wire-reinforced silicone ET tube. Soon after, the patient was agitated, moving all extremities, and biting the ET tube causing the ventilator to alarm. She was sedated and a bite-block was applied, when the ET tube’s metal reinforcing rings were noted to be permanently compressed at the teeth, with a narrowing that would not pass a suction catheter. The patient continued to show signs of airflow obstruction with PEAK – PLATEAU of 26 cm H2O, and was intermittently air hungery which light sedation alleviated. Exchanging the ET tube was discussed with the medical team, who elected to leave the damaged tube in place and manage symptoms because of the difficult first intubation. The patient did well in spite of the compressed tube until extubation on the second ICU day. No further airway issues were noted and the patient was discharged eight days later.

Discussion: With standard ET tubes, biting causes an obstruction lasting only as long as the patient actively bites the tube and causes no permanent damage outside of tube sidewall or pilot balloon line tears. A standard tube’s elastic recoil springs it open again once biting ceases. Bite-blocks address this concern, but are often large and cumbersome, and our facility applies them only when necessary in order to minimize oral tissue breakdown. The type of ET tube used with this patient features a metal coil running down the length of the ET tube to improve the flexible silicone tube's luminal ridgidity. When bitten, that metal coil becomes permanently compressed, thereby at least partially occluding the ET tube. For that reason, we believe it has greater safety risks, and recommend its use only for patients who can not be managed with standard ET tubes, and then only with a mandatory bite-block at all times.

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