Airway obstruction by a folding metal rod within a Reinforced Oral tracheal Tube: Case Report

The Reinforced Orotracheal Tube (ROT) is an airway device for intubation that allows invasive ventilation during general anesthesia. The ROT differs from a Conventional Endotracheal Tube (CET) by the presence of a stainless-steel spiral, which strengthens the wall and hinders collapse. The ROT can be used when there is a risk of obstructing the flow of gases through compression or elbowing of the endotracheal tube, during orofacial surgical procedures, neurosurgery or in non-supine surgical positions under deep general anesthesia. The metallic spiral, which reinforces the lumen of this endotracheal tube, is subject to damage and deformities that can compromise the permeability of its lumen. The ROT should be used only during the surgical procedure under deep general anesthesia. If there is a need for the permanence of orotracheal intubation in the postoperative period of patients referred to the intensive care unit, the ROT should be replaced by the polyvinyl chloride CET, given the risk of damage to the ROT due to bites with fracture of the metal rod and obstruction by folding, as in this case, which will be reported below. The rarity of similar reports in the literature and the severity of obstruction of an endotracheal tube causing severe hypoxemic disorders, guided the objective of this case report, which aims to guide preventive and resolving measures, in addition to including to the list of diagnoses of causes of acute obstructions of an endotracheal tube. Keywords: Airway obstruction; Armoured tube; intubation: mechanical ventilation.