A Rare Airway Obstruction Caused by Dissection of a Reinforced Endotracheal Tube

Background: Endotracheal tube (ETT) obstruction or narrowing in patients undergoing general anesthesia due to dissection of reinforced ETT is unusual. Case Report: A 26-year-old woman was transferred to the emergency department due to drowsy mental status after surgery. She was intubated by reinforced ETT with grossly normal external appearance, but the inner layer of ETT was dissected, the inner diameter was narrowed, and the extent of protrusion of inner layer of ETT was more severe at the distal end. Therefore, the patient had to breathe through a very small diameter ETT, and hypercapnia and CO₂ narcosis developed. Why Should an Emergency Physician Be Aware of This?: Although rare, obstruction by dissection of ETT can be life-threatening if diagnosis is delayed. Therefore, emergency physicians should keep in mind the possibility of ETT dissection when peak airway pressures or EtCO₂ values are elevated in intubated patients.