Complete Endotracheal Tube Transection by Patient Bite: A Case Report and Algorithm for Fragment Identification and Extraction

Annette Ilg; Matthias Eikermann; Andrew J Synn

doi:10.1213/XAA.0000000000001428

Complete Endotracheal Tube Transection by Patient Bite: A Case Report and Algorithm for Fragment Identification and Extraction

A A Pract. 2021 Mar 19;15(3):e01428. doi: 10.1213/XAA.0000000000001428.

Authors

Annette Ilg^{1

2}, Matthias Eikermann², Andrew J Synn³

Affiliations

¹ From the Department of Emergency Medicine.
² Department of Anesthesia, Critical Care & Pain Medicine.
³ Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

PMID: 33740790
DOI: 10.1213/XAA.0000000000001428

Abstract

We describe a case of a complete endotracheal tube (ETT) transection due to patient bite. The patient was intubated for postoperative pneumonia; during weaning of sedation, the patient was unable to tolerate pressure support ventilation (PSV) due to agitation. Adaptive support ventilation (ASV) improved patient comfort substantially. During a routine Spontaneous Breathing Trial (SBT) on PSV, the patient bit through the ETT, resulting in complete transection and an unsecured 20-cm airway fragment. Utilizing a multidisciplinary approach, we provided respiratory support and performed nasopharyngolaryngoscopy (NPL) to identify and extract the foreign body. An algorithm for management of ETT fragment extraction is provided.

Publication types

Case Reports

MeSH terms

Algorithms
Humans
Intubation, Intratracheal* / adverse effects
Positive-Pressure Respiration
Respiration, Artificial*
Ventilator Weaning