Pilot balloon malfunction caused by endotracheal tube bite blocker.

A patient’s bite is a frequent cause of endotracheal tube (ETT) obstruction, which affects the volume and pressure delivered by the ventilator. Bite-related ETT obstruction is a frequent cause of ventilator alarm activation, and can cause respiratory failure, negative-pressure pulmonary edema, and ETT tube/pilot tube damage. Clinicians formerly used objects (syringes, tongue depressors, gauze) or devices intended for other goals (ie, oropharyngeal airways or intermolar devices) to prevent the patient from biting the ETT, but those devices were often makeshift, not designed for prolonged use, and had risks such as accidental dislodgement, ulcers, aspiration, ischemia, and temporomandibular joint injury. Thus, commercially available, plastic bite blocks, which encase and protect the ETT, are now commonly used. These bite blocks have a low profile and some double as tube holders. These devices come in single sizes for adults or children. They are easy to use and thus are becoming ubiquitous. The placement of a bite block on the ETT is mainly left to clinician intuition, and, although instructions and policies may exist, bite-block placement and troubleshooting come from experience.