Patient's Elevated Airway Pressure Puzzles Providers

Conclusion In this case, the patient’s high airway pressures continued even after she was removed from the ventilator, as evidenced by the difficulty with manual ventilation. Thus, the problem wasn’t with the ventilator or its tubing. The endotracheal tube was properly placed, as evidenced by the presence of bilateral breath sounds, its depth and placement as visualized on chest X-ray. And the tube didn’t appear to be kinked or otherwise obstructed based upon the ability to easily pass an endotracheal suction catheter. Given the wheezing heard on auscultation—and even though the patient had no history of pulmonary disease—bronchodilators were administered but failed to improve the airway pressures. No other abnormal lung sounds were appreciated, her chest X-ray failed to demonstrate any other pathology, and she was unresponsive, so inadequate sedation didn’t seem to be of concern. The patient then underwent a CT scan of her chest to exclude a pulmonary embolus or other pathology, and it was through this procedure that the cause of her airway obstruction was found: Although placed at a proper depth, the beveled end of the endotracheal tube was aligned with the wall of the trachea and the only means of ventilating the patient was the “Murphy eye.” (See Figure 4.) Figure 4: Beveled end of endotracheal tube aligned with the wall of the trachea. Following review of this CT, the patient’s endotracheal tube was maintained at its previously placed depth and rotated ...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Airway & Respiratory Exclusive Articles Source Type: news