title: Fatal endotracheal tube obstruction due to the ball valve effect.
abstract: In patients suffering from pulmonary haemorrhage, or in patients who recently received a tracheostomy, acute occlusion of the endotracheal tube due to a blood clot is a rare, but well-known complication. Acute and complete occlusion of the tube is easily recognisable. There are various methods of removing the obstructive clot, such as using a bronchoscope with forceps, topical thrombolysis, saline lavage and suctioning. There are no guidelines concerning preventive routine bronchoscopic lavage. When there is a partial obstruction of the endotracheal tube, ventilation is possible, although high inspiratory pressures are necessary. If the clot functions as a ball valve ventil, raised intrathoracic pressure will cause right-sided heart failure or tension pneumothorax. It is important to recognise a partially obstructed tube in time and remove the obstruction.
authors.affiliation: VieCuri Medical Centre, Venlo, The Netherlands.
authors.forename: Karen Jante
authors.initials: KJ
authors.lastname: Woittiez
authors.affiliation: Department of Internal Medicine, Hospital Group Twente, Almelo, The Netherlands.
authors.forename: Arend Jan Jacob
authors.initials: AJ
authors.lastname: Woittiez
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000209:etiology*; D004868:Equipment Failure; D017809:Fatal Outcome; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D009093:Mucus