XXXX caused by the endotracheal tube tip: case report and investigation of a fatal complication of prolonged intubation.

@entity1 @entity292 @entity2003 @entity17954
CASE REPORT: A @entity1 with extensive burns was intubated with an 8.0 mm internal diameter endotracheal tube (ETT) equipped with a subglottic suction port (Mallinckrodt HiLo Evac). The ETT was secured to a left upper molar with wire sutures throughout the hospitalization course to ensure airway stability. On the 40th day of intubation, the @entity1 exsanguinated and died from a @entity17954 . Postmortem examination revealed a 1 cm lesion of the left anterior tracheal wall at the position of the ETT tip. The prolonged stationary position of the ETT was considered the primary factor responsible for the @entity292 . Yet @entity17954 normally is associated with high cuff pressures rather than with the tube tip. The special ETT construction required for the subglottic suction feature was suspected to have @entity2003 and may have played a contributory role. METHODS: The @entity2003 of the Mallinckrodt HiLo Evac was measured with a mechanical model and compared to 5 other commercially-available ETTs. @entity2003 was expressed as the force generated by the ETT tip when the tube curvature was altered by 5 cm and 10 cm of flexion from its resting position. RESULTS: The mean force exerted by the Mallinckrodt HiLo Evac was 10.1 +/- 2.8 g at 5 cm of flexion and 17.7 +/- 5.1 g at 10 cm of flexion. This was significantly greater than all other ETT brands tested (by one-way analysis of variance and Student-Newman-Kuels test, p < 0.05). CONCLUSION: This case of fatal @entity17954 formation associated with an ETT tip was unusual because of the extended duration of endotracheal intubation and the complexity of the @entity1 's airway management problems. Our data suggest that the higher @entity2003 of the HiLo Evac ETT may have contributed to @entity292 development at the tube tip. However, we do not believe that the higher @entity2003 of the HiLo Evac ETT necessarily poses any greater risk than other ETTs under normal circumstances, in which the tube tip is not fixed in a stationary position for an extended period.
