I have with interest read the Letter to the Editor by Ogden and Bradway1dealing with a unique way of restoring patency to an endotracheal tube that is kinked in a prone patient. I would like to make three points.

  1. The small flexible suction catheter they inserted through the endotracheal tube stopped at 19 cm, the point at which the pilot balloon line inserts, i.e. , where the cuff is starting to inflate. Did the authors attempt to let the cuff down? This should be considered as the first option for a possible treatment of an airway obstruction. The cuff could have herniated into the lumen of the endotracheal tube.

  2. I would think that the Berman intubating airway would be difficult to insert into the mouth of such a patient in most cases. The reasons being, as the author’s mention, edema of tongue and lips. I also suggest that it is difficult, if not impossible, to open the mouth in these cases.

  3. Another solution is to replace the angle connector at the end of the endotracheal tube with a Bronchoscopic Swivel Elbow Adaptor (PriMedicao, Largo, FL). Through the bronchoscopic port (at the top end of the connector), one can advance a gum elastic bougie or a semirigid Sheridan Jet Ventilation Catheter/endotracheal tube exchanger (Rusch. Inc. Duluth, GA) (Dacanay RG, Mecklenburg BW, Department of Anesthesiology, Naval Medical Center, San Diego, CA, written communication, May 2004) or a Cook’s exchange catheter (Cook, Critical Care, Ellettsville, IN). With these three devices, one should be able to straighten the kink.2With the two latter devices, one can also ventilate by using the orifice in the middle of these catheters.

Sudden or gradual airway obstruction in a prone patient can end in disaster. To have a Bronchoscopic Swivel Elbow Adaptor available in these cases may prove invaluable.

Stanford University School of Medicine, Stanford, California. brockutn@stanford.edu

Ogden LL, Bradway JA: Maneuver to relieve kinking of the endotracheal tube in a prone patient. Anesthesiology 2008; 109:159
Brock-Utne JG: Clinical Anesthesia: Near Misses and Lessons Learned, 1st Edition. New York, Springer, 2008, pp, 117–118
New York