0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Clinical Note |

Silicone-Based Endotracheal Tube Causing Airway Obstruction and Pneumothorax

Gregory G. Capra, MD; Anil N. Shah, MD; John D. Moore, MD; William S. Halsey, MD; Eugenio Lujan, MD
Arch Otolaryngol Head Neck Surg. 2012;138(6):588-591. doi:10.1001/archoto.2012.688.
Text Size: A A A
Published online

Extract

Silicone-based endotracheal tubes (ETTs) may be prone to intraoperative airway obstruction. The Nerve Integrity Monitoring (NIM) ETT (Medtronic Xomed Inc) is one such tube, and it is used during thyroid and parathyroid surgery for intraoperative electromyographic recurrent laryngeal nerve monitoring. The NIM ETT uses bipolar stainless steel electrodes within the silicone-based tube, which contacts both vocal cords. The specialized tube also uses a silicone elastomer cuff to allow better tracheal conformity and minimal tissue trauma.1 The designed elasticity may predispose the silicone-based cuff to asymmetrically inflate at very high cuff pressures. While a review of the literature demonstrates a single case report of cuff herniation causing an obstruction of the distal ETT in a clinical situation, the Food and Drug Administration recognizes 8 other reported events.2 We report a similar case in which ventilation with the NIM ETT was impeded by a herniated cuff, resulting in high positive pressure ventilation and subsequent bilateral pneumothorax.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Inferior cadaveric tracheal view of a 6.5 Nerve Integrity Monitoring endotracheal tube (Medtronic Xomed Inc) after injection of 10 cc of air into the silicone-based cuff, showing asymmetrical inflation of the cuff, partial obstruction of the Murphy eye port, and leftward deviation of the endotracheal tube.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Inferior cadaveric tracheal view of the Nerve Integrity Monitoring endotracheal tube (Medtronic Xomed Inc) after injection of 20 cc of air into the silicone-based cuff, showing asymmetrical inflation of the cuff and complete obstruction of the Murphy eye and distal port.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 3. Inferior cadaveric tracheal view of a 6.5 polyvinyl chloride endotracheal tube after injection of 10 cc of air, showing symmetrical inflation of tracheal cuff and unobstructed Murphy eye and distal ports.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 4. Inferior cadaveric tracheal view of a polyvinyl chloride endotracheal tube after injection of 20 cc of air, showing mild asymmetrical inflation of tracheal cuff and unobstructed Murphy eye and distal ports.

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

381 Views
1 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Silicone-based endotracheal tube causing airway obstruction and pneumothorax. Arch Otolaryngol Head Neck Surg 2012;138(6):588-91.
Jobs
JAMAevidence.com

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Airflow Limitation

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Pretest Probabilities and Likelihood Ratios for Clinical Findings

brightcove.createExperiences();