A rare cause of "cuff leak" in an endotracheal tube with an intact cuff

J. Winchester, R. Wadhwani

King's College Hospital - London (United Kingdom)

Background:
Endotracheal tube leaks are common; the consequences may range from trivial to life threatening. We report an unusual cause of endotracheal tube leak caused by a defect at the join between the inflation valve and pilot balloon of the cuff inflation system, which was not detected during initial check and is something that could be easily missed.

Case Report:
During a routine elective case in a day surgery unit, the trachea was intubated using a Portex 7.0mm cuffed endotracheal tube. After 10 minutes, the anaesthetist noticed that a tracheal seal leak had developed accompanied by partial deflation of the pilot balloon. Surgery was halted and the endotracheal tube was replaced without the patient coming to any harm. On examination of the suspected faulty endotracheal tube, there was no identifiable rip or tear to the cuff. Submersion of the inflated tube in water revealed bubbles issuing from the join between the one-way inflation valve and the main body of the pilot balloon.

Discussion:
The likely primary cause of the airway leak was a defect in the endotracheal tube at a location where leak has not been previously reported. Potential sequelae include difficulty in ventilation and failure to protect the airway from aspiration. Previous authors have suggested that a large proportion of endotracheal tubes removed for a presumed defect are flawless (1) and hence that most air leaks are due to malposition. However in this case physical evidence of a defect was identified and we have reported this to the manufacturer.

References:
1. Kearl RA, Hooper RG. Massive airway leaks: an analysis of the role of endotracheal tubes. Crit Care
Med. 1993 Apr;21(4):518–21.

Learning points:
Whilst endotracheal tube cuff leaks are commonly related to malposition, clinicians should consider the possibility of damage or defect in the inflation system.

11 / A rare cause of cuff leak in an endotracheal tube with an intact cuff