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Identifying and Managing a Malpositioned Endotracheal Tube Bite Block in an Orotracheally Intubated Patient

View Article: PubMed Central - PubMed

ABSTRACT

The universal bite block is increasingly used in orotracheally intubated patients. Here, we report a case of pilot tube dysfunction caused by a malpositioned universal bite block in an orotracheally intubated patient. We summarize the key points on identifying and managing a malpositioned universal bite block from this case and literature review.

A 74-year-old woman was emergently intubated during an episode of hyperkalemia-related cardiac arrest. A universal bite block was used for fixing the endotracheal tube. After her condition stabilized, ventilator weaning was attempted; however, a positive cuff-leak test result was observed.

The cuff-leak test revealed a lack of elasticity of the pilot balloon, which was completely deflated after 2 mL of air was removed. Pilot tube dysfunction was highly suspected. The bite block was slightly pulled out, and 8 mL of air was aspirated from the pilot tube. The patient was successfully extubated without stridor and respiratory distress.

Our case highlighted that a malpositioned bite block may obstruct the pilot tube, causing unfavorable consequences. While fixing the bite block on an endotracheal tube, it is crucial to ensure that the takeoff point of the pilot tube is located within the C-notch of the bite block.

No MeSH data available.


Related in: MedlinePlus

Simulated conditions of a malpositioned bite block causing pilot tube kinking.
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Figure 2: Simulated conditions of a malpositioned bite block causing pilot tube kinking.

Mentions: After the medical condition of the patient stabilized in the ICU, ventilator weaning was initiated. On the third ventilator day, the patient passed a spontaneous breathing trial with a T-piece. A cuff-leak test was conducted on volume control ventilation before the extubation attempt. The settings of the test were as follows: tidal volume set 600 mL; post-deflation tidal volume 600 mL; air leakage 0 mL (0%); predeflation airway pressure 30 cm H2O; and postdeflation airway pressure, 30 cm H2O. The patient had no cough after cuff deflation, suggesting a positive cuff-leak test result. In our hospital, a positive cuff-leak test is defined as a leak <110 mL or <15% of tidal volume or absence of cough.5 However, although the endotracheal tube cuff was deflated, the pilot balloon was completely deflated after 2 mL of air was removed. Although the cuff was reinflated, only 2 mL of air could be added. The pilot balloon exhibited a lack of elasticity. A detailed patient examination revealed that the endotracheal tube cuff pressure was 25 cm H2O, and the pilot tube was not twisted. However, the takeoff point of the pilot tube was not visible (Figure 1). To ensure that the bite block did not compress the pilot tube or takeoff point, it was slightly pulled out. Furthermore, 8 mL of air was aspirated from the pilot tube after adjustment of the bite block position, and the patient was successfully extubated without stridor and respiratory distress. The cuff and pilot tube were re-examined after the endotracheal tube was removed from the patient, and they showed normal functioning. Pilot tube kinking because of the compression by the endotracheal tube bite block was considered to cause the pilot tube dysfunction in this case (Figure 2).


Identifying and Managing a Malpositioned Endotracheal Tube Bite Block in an Orotracheally Intubated Patient
Simulated conditions of a malpositioned bite block causing pilot tube kinking.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998396&req=5

Figure 2: Simulated conditions of a malpositioned bite block causing pilot tube kinking.
Mentions: After the medical condition of the patient stabilized in the ICU, ventilator weaning was initiated. On the third ventilator day, the patient passed a spontaneous breathing trial with a T-piece. A cuff-leak test was conducted on volume control ventilation before the extubation attempt. The settings of the test were as follows: tidal volume set 600 mL; post-deflation tidal volume 600 mL; air leakage 0 mL (0%); predeflation airway pressure 30 cm H2O; and postdeflation airway pressure, 30 cm H2O. The patient had no cough after cuff deflation, suggesting a positive cuff-leak test result. In our hospital, a positive cuff-leak test is defined as a leak <110 mL or <15% of tidal volume or absence of cough.5 However, although the endotracheal tube cuff was deflated, the pilot balloon was completely deflated after 2 mL of air was removed. Although the cuff was reinflated, only 2 mL of air could be added. The pilot balloon exhibited a lack of elasticity. A detailed patient examination revealed that the endotracheal tube cuff pressure was 25 cm H2O, and the pilot tube was not twisted. However, the takeoff point of the pilot tube was not visible (Figure 1). To ensure that the bite block did not compress the pilot tube or takeoff point, it was slightly pulled out. Furthermore, 8 mL of air was aspirated from the pilot tube after adjustment of the bite block position, and the patient was successfully extubated without stridor and respiratory distress. The cuff and pilot tube were re-examined after the endotracheal tube was removed from the patient, and they showed normal functioning. Pilot tube kinking because of the compression by the endotracheal tube bite block was considered to cause the pilot tube dysfunction in this case (Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

The universal bite block is increasingly used in orotracheally intubated patients. Here, we report a case of pilot tube dysfunction caused by a malpositioned universal bite block in an orotracheally intubated patient. We summarize the key points on identifying and managing a malpositioned universal bite block from this case and literature review.

A 74-year-old woman was emergently intubated during an episode of hyperkalemia-related cardiac arrest. A universal bite block was used for fixing the endotracheal tube. After her condition stabilized, ventilator weaning was attempted; however, a positive cuff-leak test result was observed.

The cuff-leak test revealed a lack of elasticity of the pilot balloon, which was completely deflated after 2&#8202;mL of air was removed. Pilot tube dysfunction was highly suspected. The bite block was slightly pulled out, and 8&#8202;mL of air was aspirated from the pilot tube. The patient was successfully extubated without stridor and respiratory distress.

Our case highlighted that a malpositioned bite block may obstruct the pilot tube, causing unfavorable consequences. While fixing the bite block on an endotracheal tube, it is crucial to ensure that the takeoff point of the pilot tube is located within the C-notch of the bite block.

No MeSH data available.


Related in: MedlinePlus