Endotracheal tube cuff leak: yet another unusual cause!

Abstract

Citation: Lakesh AK, Kapoor D, Singh A. Endotracheal tube cuff leak: yet another unusual cause! Anaesth Pain & Intensive Care 2014;18(3):317-18

Despite routine practice of pre-use visual inspection and testing of ETT for physical defects, some manufacturing defects still go unnoticed and may lead to partial or complete failure of ventilation in intubated patient.^1-4 A 36-year-old female, ASA physical status I, weighing 45 kg, was scheduled for elective laparoscopic cystectomy for ovarian cyst. Standard GA and monitoring techniques were employed. After routine pre-use check for any visible physical defects, a 7.5 mm internal diameter cuffed ETT (InTube^® Intersurgical Ltd., UK) was selected for orotracheal intubation. Correct ETT position was confirmed by end-tidal carbon dioxide (EtCO₂) trace. A close circle system was used and ventilator adjusted to achieve effective oxygenation (SpO₂ ≥ 95%) and ventilation (EtCO₂ 35-40 mmHg) with volume-controlled mode. Pneumoperitoneum with carbon dioxide was created and intra-abdominal pressure was held at 12 mmHg. Patient was then placed in Trendelenberg’s and lithotomy position. Within few minutes after the commencement of surgery, we noticed the collapsing ventilator bellows and air leak from the mouth as evident by a bubbling sound. Surgery was stopped and pneumoperitoneum released. Patient was placed in supine position and ETT position was confirmed by chest auscultation and ETT marking at the level of the lips. The pilot balloon was found partially deflated and was re-inflated with air. However, after few minutes, air leakage with a deflated pilot balloon was noticed again. Suspecting a possible damage of the ETT cuff or inflation assembly, the ETT was immediately replaced by a fresh ETT of same size. Subsequently no further problems were observed and the surgery was completed uneventfully.