Abstract
Purpose
To present a case of laryngeal damage in an infant caused by a too large and inappropriately designed cuffed tracheal tube.
Clinical features
A 13-month-old child undergoing cardiac surgery was intubated with an uncuffed endotracheal tube with an internal diameter (ID) of 4.0 mm. Because of an important air leak around the tracheal tube during mechanical ventilation, a cuffed endotracheal tube lD 4.0 mm was inserted. The air leak with the tube cuff not inflated was acceptable at 25 cm H2O airway pressure. After extubation on the third postoperative day the patient showed increasing stridor and respiratory deterioration. Fibreoptic laryngoscopy of the spontaneously breathing patient showed a large intra-laryngeal web. After surgical removal of the web, the child rapidly recovered and was discharged from the hospital on the 12th postoperative day.
Inspection of the 4.0 mm (ID) cuffed tracheal tube revealed a cuff positioned inappropriately high and an increase of 0.7 mm in outer tube diameter compared to the 4.0 mm (lD) uncuffed tracheal tube from the same manufacturer. The tube cuff is likely to be situated within the larynx when placed in accordance to insertion depth formulas or radiological criteria, as used for uncuffed tracheal tubes in children.
Conclusion
The larger than expected tracheal tube with its intralaryngeal cuff position in a 13-month-old child likely caused mucosal damage and an inflammatory reaction within the larynx resulting in granulation tissue formation and fibrous healing around the tracheal tube.
Résumé
Objectif
Présenter un cas de lésion laryngée causée, chez un enfant, par un tube trachéal à ballonnet, trop grand et mal conçu. Élémentscliniques : Un enfant de 13 mois devant subir une intervention cardiaque a été intubé avec un tube endotrachéal sans ballonnet d’un diamètre interne (Dl) de 4,0 mm. Étant donné l’importante fuite d’air autour du tube trachéal pendant la ventilation mécanique, un tube endotrachéal à ballonnet de 4,0 mm de Dl a été inséré. La fuite d’air notée autour du ballonnet non gonflé était acceptable pour une pression des voies aériennes de 25 cm H2O. Après l’extubation, au troisième jour postopératoire, le patient a présenté un stridor croissant et une détérioration respiratoire. La fibroscopie du larynx pendant la respiration spontanée a montré une grande membrane intralaryngée. Après le retrait chirurgical de la membrane, l’enfant s’est rapidement rétabli et a quitté l’hôpital le 12e jour.
Lexamen du tube à ballonnet de 4,0 mm a révélé un ballonnet placé trop haut et une augmentation de 0,7 mm du diamètre extérieur du tube, comparé au tube sans ballonnet de 4,0 mm réalisé par le même fabricant. Le ballonnet se situe à l’intérieur du larynx quand on place le tube selon les formules d’insertion ou les critères radiologiques, comme on le fait avec les tubes trachéaux sans ballonnets chez les enfants.
Conclusion
Le tube trachéal, plus gros que prévu, placé dans le larynx dans la position indiquée pour un tube à ballonnet chez un enfant de 13 mois, a causé une lésion de la muqueuse et une réaction inflammatoire dans le larynx, ce qui a entraîné la formation de tissu de granulation et une cicatrisation fibreuse autour du tube trachéal.
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Dillier, C.M., Trachsel, D., Baulig, W. et al. Laryngeal damage due to an unexpectedly large and inappropriately designed cuffed pediatric tracheal tube in a 13-month-old child. Can J Anesth 51, 72–75 (2004). https://doi.org/10.1007/BF03018551
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DOI: https://doi.org/10.1007/BF03018551