Use of ETView Tracheoscopic Ventilation Tube® in airway management of a patient with tracheal injury.

I tracheobronchial injuries are fatal complications requiring immediate diagnosis and treatment. Unintentional one sided intubation, endotracheal tube cuff over-inflation, direct trauma with guides or boogie’s, double-lumen tube employment, tube replacement without cuff deflation and coughing against closed or blocked ventilation circuits are the possible causes.1, 2 Emergency or difficult intubation also increases the risk of tracheal wall injuries.3 The ETView Tracheoscopic Ventilation Tube® (ETView TVT®, Misgav, Israel) is a standard endotracheal tube connected with an embedded miniature video camera, a light source and an irrigation port.4 It enables real time video images from tracheal lumen to verify the correct placement of the tube and view the pathologies in the tracheal lumen. We want to report, successful airway management with ETView TVT® in a patient with iatrogenic tracheal injury. Written informed consent was obtained from her relatives. An 87-year-old woman who had been under observation for one day at the emergency unit suffered from cardiac arrest. During the cardiopulmonary resuscitation the patient was intubated and manually ventilated with a self-inflated bag. In a couple of minutes spontaneous circulation was restored, but SpO2 was below 80% despite pure oxygen and high inspiratory pressures and massive subcutaneous emphysema was observed. Computerized tomography imaging revealed a large fullthickness tracheobronchial injury due to over inflation of the tracheal cuff, pneumothorax at the right lung, and massive subcutaneous emphysema. Urgent fiber-optic video bronchoscopy and esophagoscopy revealed a huge laceration at the posterior wall of the trachea beginning just under the vocal cords and ending 1 cm over the tracheal carina. During fiber-optic bronchoscopy, severe desaturation occurred due to the impairment in mechanical ventilation. Patient was immediately transferred to the operating room, for endobronchial intubation. The tube could not be introduced over the fiber-optic endoscope easily and for the risk of expanding the laceration, patient was reintubated with an ETView TVT® no. 7.0 (ID). Injury at the Use of ETView Tracheoscopic Ventilation Tube® in airway management of a patient with tracheal injury