ABSTRACT

In cases of sudden hypercapnia developing in a mechanically ventilated patient, obstruction of the endotracheal tube (ETT) should be suspected first at the outset. Herein we aimed to show that one–way valve type ETT obstruction is a major clinical event that can lead to patient morbidity and mortality in mechanically ventilated intensive care unit (ICU) patients. Case Report: A 74-year-old male who had coronary artery disease and di-abetes mellitus and developed pneumonia after coronary by-pass surgery could not be extubated in the cardiovascular surgery unit and was sent to our ICU on the 35th day of the postoperative period. After 12 hours, the pa-tient had developed bradycardia and cardiac arrest. The patient underwent approximately 40 minutes of cardiopulmonary resuscitation (CPR) prior to recovery. However, PaCO2 and PaO2 were 116 and 83 mmHg respecti-vely. Lung sounds were not heard on auscultation bilaterally. With these findings, pneumothorax was suspected due to rib fractures that developed after CPR and anterior midclavicular thoracentesis was performed with 2nd intercostal access bilaterally. Three milliliters of hemorrhagic materi-al containing air was aspirated totally. Thirty minutes after thoracentesis, a chest X-ray showed pneumothorax bilaterally; thus a bilateral chest tube was placed. In the 90th minute, ventilation could not be achieved either by respirator or bag-valve device and then the ETT was changed and a large plug was detected. After reintubation vital signs and blood gases returned to normal limits. Conclusion: In this case we thought that the suctioning tubes had pushed the plug into the trachea and caused diagnostic difficul-ties. For patients who are on long-term ventilatory support, humidification systems must be used. If the patients develop sudden ventilation difficulti-es, the ETT must be changed before the other procedures.