Bougie related airway incident

Abstract

Senior Consultant in Intensive Care Medicine, Jurong Health Services, 1 Jurong East Street 21, Singapore 609606

Airway incident following use of a Bougie to exchange a tube. A 35 year old male, intubated with 7 mm ID ETT for respiratory distress (Gr IIb view). He remained on the ventilator a week following his admission and was not expected to be weaned off in the next one week. I decided to proceed with tracheostomy. To facilitate bronchoscopic facilitation of the tracheostomy, it was decided to change the tube to a 8.0 mm ID over a bougie (rather than an Airway Exchange Catheter). The exchange was uneventful and did not encounter any resistance.

As the team was preparing for the tracheostomy, the PIP alarm kept going off. There was also dropping P/F. Insertion of a suction catheter yielded blood. Large clots were noted in the airway on FOB. Oxygenation or ventilation issue did not improve despite removal of multiple small clots. The patient continued to saturate around 90% with FiO2 of 1.0.
The tube was removed and another tube inserted over an Airway Exchange Catheter. We were surprised to see the clot at the end of the ETT.
Following placement of the new tube above the carina, we had no further issues. We could clear out the airway. We proceeded with the tracheostomy the next day. Following tracheostomy, we performed a bronchoscopy to identify site of bleeding, but found nothing.