Case 48: Is the Patient Extubated?

Abstract

You are called urgently to the ICU as the nurse can hear air escaping from the mouth of a 35-year-old morbidly obese patient. He is in the ICU recovering from a motor vehicle accident. When you arrive, his oxygen saturation is 84%, HR 110, and BP 130/90. You can easily hear the air escaping from his mouth. The nurse tells you that his oxygen saturation was, until a few minutes ago, 96% on FiO₂ of 100%. His face is severely swollen and he has large, thick neck with a diameter over 70 cm. The latter has been shown to indicate a difficult endotracheal intubation [1]. As you are about to let the pilot balloon down to advance the ETT further into the trachea, you discover that the pilot balloon is totally collapsed. You now discover that it will not inflate as it has a hole in it. You are reluctant to change the existing ETT with a tube changer as this may take too much time. Delaying the change of ETT could lead to a dramatic fall in oxygen saturation, with potentially disastrous consequences.