ETT death : Mediastinis

Started by yogenbhatt1, November 09, 2011, 07:20:28 AM

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yogenbhatt1

Got called for an ETT placement by an Anaesthesiologist. They had tried but failed to intubate. Postponed to next day and I was invited to intubate.
The Anaesthesiologist was quite senior. I told him that, if you could not intubate, chances are that I will also not be able to do it. Why not invite a chest physician who has a Bronchoscope? We did that and tube was placed by Chest Physician with a conscious patient. Later we gave GA and finished the surgery.. Extubated the patient when all was over and patient was fully conscious. All was ok.
Patient worsened next day onwards and developed ARDS and was transferred to higher institution where the patient succumbed to death.
Diagnosis was Mediastinitis. May be the Esophagus was perforated in the first attempt?
Any such experience to share?

jafo1964

Sir
Many such instances have been encountered in teaching institutes where sometimes PGs on the learning curve end up with
My mind recalls this case
Young ASA 1 patient posted for uro-gynecological repair for complication after delivery
Assessment revealed a Mallampati score of 3 with IID, MTD and neck movements being normal. She had no other markers to predict a DA scenario.
I cant recollect why a GA was planned on her but i guess in those days with a paucity of epidural catheters and considering the length of surgery a GA might have been planned
That was the Pre-GEB era
After induction intubation failed
so a metal ETT introducer or stilette was used to mould the tube and I think intubation was  successful in the 2nd or 3rd pass
Rest of intra-op period went uneventfully
1st POD was unremarkable except for fever.
Oral fluids were started on day 2 and patient developed cough, wheeze, desaturation and progressive deterioration needing intubation and ventilation
A diagnosis of possible TE Fistula due to injury during intubation was diagnosed.
We lost the patient on day 5.
I am certain that a large number of such cases may have gone unreported

But the introduction of Sialastic GEB have certainly helped to overcome trauma that our old metal stillettes produced

regs

yogenbhatt1

Hi, Sir,
Your reply is so apt.
This must be happening quite often, but luckily nothing happens to the patient.
Though patient safety of LMA is always questioned, is ETT without a bad track record?