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| LETTERS TO EDITOR |
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| Year : 2019 | Volume
: 20
| Issue : 1 | Page : 49-50 |
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Broken endotracheal tube connector as a cause of ventilation failure
Hemlata, Sateesh Verma, Ahsan Khaliq Siddiqui
Department of Anaesthesiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| Date of Web Publication | 6-May-2019 |
Correspondence Address:
Dr. Hemlata
Type IV/3, SGPGI Campus, Lucknow - 226 014, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/TheIAForum.TheIAForum_20_19
How to cite this article:
Hemlata, Verma S, Siddiqui AK. Broken endotracheal tube connector as a cause of ventilation failure. Indian Anaesth Forum 2019;20:49-50 |
Sir,
Despite the standard practice of visual inspection of endotracheal tubes (ETTs) for physical defects and testing the integrity of the cuff prior to use, many structural defects can go unnoticed during preuse check which can be catastrophic. There are many case reports of structural defects in the ETTs leading to airway obstruction,[1],[2] but very few reports of ventilation failure due to air leakage as a result of structural ETT defects.[3] We report a case of ventilatory failure as a consequence of broken ETT connector.
A 31-year-old male having recurrent right-sided maxillary region ameloblastoma was scheduled for excision through lateral orbitotomy and reconstruction using temporalis muscle. After checking anesthesia machine and other equipment and preparing all the medications, an 8.5-mm ID ETT (PolyMedicure Limited, Faridabad, Haryana, India) was selected and its lumen and cuff were checked. After induction of anesthesia with propofol and neuromuscular blockade with vecuronium, the patient was intubated by a resident. The tube was connected to breathing circuit with a mainstream capnograph for ETCO2 monitoring. However, when we tried to ventilate the patient, there was no chest expansion, no breath sound on auscultation, and hardly any rise of capnography curve from the baseline. Initial suspicion of esophageal intubation was ruled out as the intubation was under vision, and other causes such as any leak or disconnection in circuit were looked into. At this point, it was noted that there was a large crack in the connector of ETT [Figure 1] which was responsible for massive leak resulting in inability to ventilate the patient. The connector was immediately taken out from the ETT, and another connector (taken out from a new 8.5-mm ID ETT) was inserted into the tube. Thereafter, it became possible to ventilate the patient adequately, and capnography showed a normal waveform. The patient's oxygen saturation remained adequate throughout. | Figure 1: Broken endotracheal tube connector (a) resulting in significant area of air leak in the circuit (b)
Click here to view |
Heitz and Franze reported a case in which the T-connector broke upon removal of the stylet while intubating the patient.[4] In our case, the connector was broken either during storage and the defect went unrecognized during preuse check or it got broken by resident while intubating or connecting it to the circuit. Although it was a minor defect which could easily be rectified by replacing the defective connector with a new one from another ETT of same size, failure to do so in a timely manner can delay the initiation of ventilation which at times may be life-threatening, especially in pediatric patients and in patients with low pulmonary reserve. There is an added risk of foreign body aspiration if the broken segment gets impacted in the lumen of the ETT.[5]
The purpose of reporting this incident is to re-emphasize the importance of thorough preuse check of each and every part of ETT as well as of having a second ETT of same size ready in addition to that of other sizes. Moreover, the clinicians should also be vigilant enough to avoid any anesthetic mishap by prompt recognition of such equipment malfunction and appropriate intervention, thereby preventing life-threatening complications.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Sofi K, El-Gammal K. Endotracheal tube defects: Hidden causes of airway obstruction. Saudi J Anaesth 2010;4:108-10.  [ PUBMED] [Full text] |
| 2. | Bharti N, Bala I, Sharma K. Endotracheal tube connector defect as a cause of high airway pressure. Paediatr Anaesth 2012;22:502-3. |
| 3. | Asai T, Johmura S, Shingu K. Failed ventilation due to breakage of a tracheal tube connector. Anaesthesia 2000;55:915-6. |
| 4. | Heitz JW, Franze VP. Inopportune breakage of an endotracheal tube T-connector. Can J Anaesth 2007;54:958. |
| 5. | Yapici D, Atici S, Birbicer H, Oral U. Manufacturing defect in an endotracheal tube connector: Risk of foreign body aspiration. J Anesth 2008;22:333-4. |
[Figure 1]
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