Tracheal Foreign Body

A 7 month-old intact male German Shepherd was anesthetized for a bandage change to care for extensive soft tissue wounds after being hit by a car.  The dog had an unexpectedly rapid recovery, and bit the endotracheal tube before being extubated.  The endotracheal tube became lodged in the dog’s trachea and was not able to be removed orally.  The patient developed increased respiratory rate and effort shortly after recovery and was referred to removal of the damaged entrotracheal tube.

Upon presentation, the dog was in moderate respiratory distress, with increased respiratory rate and effort.   Course pulmonary parenchymal crackles were heard, which were worse in the right hemithorax. The patient was placed in supplemental oxygen, but his respiratory signs did not improve.  He was heavily sedated and re-intubated with the cuff of the endotracheal tube just distal to the larynx.

What options exist for removing the endotracheal tube?

Since the tube was bitten, will the cuff of the endotracheal tube be inflated?  Does it matter?

Tracheoscopy was performed through the endotracheal tube using a flexible endoscope and revealed the following image.

Alligator forceps were advanced into the working channel of the flexible scope and used to grasp the wall of the endotracheal tube.  Once securely held with the forceps, the chewed tube was pulled cranially until it was against the distal end of the scope.

The endoscope was withdrawn into the endotracheal tube used to intuabte the patient.  The patient was extubated with the scope inside the endotracheal tube and the chewed tube held against the tube being used to intubate the patient.  The patient was reintubated, and tracheoscopy and bronchoscopy revealed the follow findings.

If tracheoscopy was not available, is there another minimally invasive option to remove the tube from the distal trachea?

What are the post-procedural management and monitoring concerns for this patient?

Tags: cases

Category: Cases, Endoscopy, Respiratory