Acute and Critical Care

Case Report

Pulmonary
A Reinforced Endotracheal Tube Completely Severed by a Patient Bite and Lodged in the Right Main Bronchus: Susie Yoon, Hyunjung Choo, Se Eun Kim, Heeyeon Kwon, Hannah Lee; Korean J Crit Care Med. 2017;32(1):70-73. Published online November 14, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00437

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Reinforced endotracheal tubes (ETTs) are designed to resist kinking or compression. However, these have a potential risk of being obstructed or severed by a patient’s bite. We report a case in which a reinforced ETT was severed by tube-bite while the patient was in the prone position during an intensive care unit stay. Bronchoscopic evaluation showed that the severed distal part of the tube had lodged in the patient’s right main bronchus, and it had to be surgically removed. The patency of reinforced ETTs should be carefully monitored in patients intubated in the prone position.

Citations

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British Journal of Hospital Medicine.2022; 83(5): 1. CrossRef
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Samuel Wiles, Eduardo Mireles-Cabodevila, Scott Neuhofs, Sanjay Mukhopadhyay, Jordan P. Reynolds, Umur Hatipoğlu
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Original Article

Pulmonary
The Effect of Positive End-Expiratory Pressure on Air Leakage: Comparison of Cuff Designs: Junyong In, Gyung Serk Shim, Seunghyun Chung; Korean J Crit Care Med. 2014;29(1):3-6. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.3

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Abstract PDF

Background
Recently developed taper-shaped cuffs (TG cuffs) of endotracheal tubes (ETTs) are known to have a more potent sealing effect than cylindrical high-volume low-pressure cuffs (HL cuffs) of conventional ETTs. The aim of this study was to compare TG cuffs with HL cuffs of ETTs in a bench-top model with regard to air leakage under various positive end-expiratory pressures (PEEP).
Methods
HL cuffs and TG cuffs made from PVC were included (HL group vs. TG group). A model trachea with an internal diameter (ID) of 22 mm was attached to a test lung. The test lung was ventilated using an anesthesia respirator with volume controlled mode and PEEPs of 0, 5, 10, or 15 cm H₂O. Using spirometry, percentages of expired to inspired tidal volumes (TVe/i) were calculated as a measure of air leakage.
Results
With regard to PEEPs, the HL group showed significantly higher air leakage compared to the TG group (p < 0.0001), and a higher PEEP resulted in greater air leakage (p < 0.0001). Air leakage with higher PEEP was greater in the HL group than in the TG group at ID 7.0 mm and 7.5 mm (p = 0.0467, p = 0.0045)
Conclusions
This study shows the superior sealing ability of the TG cuff during ventilation at various PEEPs.

Citations

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Alexandra J. Berges, Ioan A. Lina, Rafael Ospino, Hsiu‐Wen Tsai, Dacheng Ding, Jessica M. Izzi, Alexander T. Hillel
Otolaryngology–Head and Neck Surgery.2022; 167(4): 716. CrossRef
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