Limits...
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

Algorithm proposed for evaluating and managing pilot tube obstruction in case of an appropriately placed universal bite block.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4998396&req=5

Figure 3: Algorithm proposed for evaluating and managing pilot tube obstruction in case of an appropriately placed universal bite block.

Mentions: A small amount of air (<2 mL) being required for deflating the pilot balloon is a crucial indicator of pilot tube obstruction.2 The lack of elasticity of the pilot balloon can be observed simultaneously after cuff inflation. When pilot tube obstruction is suspected, the pilot tube should be inspected to ensure that it freely moves from the endotracheal tube without obstruction through the takeoff point level because the pilot tube and its wall should be smooth without kinking. Moreover, the takeoff point of the tube should be examined to ensure that it is located within the C-notch of the universal bite block. If the takeoff point is not visible, its relative position to the bite block should be further assessed. Because the takeoff point of a pilot tube on an endotracheal tube varies with the size and brand of the tube,2 a same-sized endotracheal tube can be used for simulating the relative position between the bite block and takeoff point of the pilot tube. The range covered by a universal bite block can be estimated by summing its fixation depth (Figure 1A, labeled d) and length (Figure 1A, labeled f). Furthermore, the location of the takeoff point of the pilot tube and the range covered by the bite block should be compared. If the bite block overlaps with the takeoff point of the pilot tube, the takeoff point must be visibly located within the C-notch of the bite block or the bite block should be pulled out to prevent compression of the takeoff point. Figure 3 presents an algorithm proposed for evaluating and managing pilot tube obstruction based on the present case and review of relevant literature.2,6–9


Identifying and Managing a Malpositioned Endotracheal Tube Bite Block in an Orotracheally Intubated Patient
Algorithm proposed for evaluating and managing pilot tube obstruction in case of an appropriately placed universal bite block.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Algorithm proposed for evaluating and managing pilot tube obstruction in case of an appropriately placed universal bite block.
Mentions: A small amount of air (<2 mL) being required for deflating the pilot balloon is a crucial indicator of pilot tube obstruction.2 The lack of elasticity of the pilot balloon can be observed simultaneously after cuff inflation. When pilot tube obstruction is suspected, the pilot tube should be inspected to ensure that it freely moves from the endotracheal tube without obstruction through the takeoff point level because the pilot tube and its wall should be smooth without kinking. Moreover, the takeoff point of the tube should be examined to ensure that it is located within the C-notch of the universal bite block. If the takeoff point is not visible, its relative position to the bite block should be further assessed. Because the takeoff point of a pilot tube on an endotracheal tube varies with the size and brand of the tube,2 a same-sized endotracheal tube can be used for simulating the relative position between the bite block and takeoff point of the pilot tube. The range covered by a universal bite block can be estimated by summing its fixation depth (Figure 1A, labeled d) and length (Figure 1A, labeled f). Furthermore, the location of the takeoff point of the pilot tube and the range covered by the bite block should be compared. If the bite block overlaps with the takeoff point of the pilot tube, the takeoff point must be visibly located within the C-notch of the bite block or the bite block should be pulled out to prevent compression of the takeoff point. Figure 3 presents an algorithm proposed for evaluating and managing pilot tube obstruction based on the present case and review of relevant literature.2,6–9

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