ENDOTRACHEAL-TUBE AND TRACHEOBRONCHIAL OBSTRUCTION AS CAUSES OF HYPOVENTILATION WITH HIGH INSPIRATORY PRESSURES

Two cases of difficult ventilation are presented, the first caused by endotracheal tube obstruction with nasal turbinate, and the second cau sed by tracheobronchial obstruction with blood clots. The clinical pre sentation in each case was characterized by extreme difficulty in vent ilating and severe hypercapnia despite vigorous ventilatory efforts wi th either a mechanical ventilator or resuscitator bag. A simple manipu lation of the endotracheal tube cuff helped to differentiate between i ncreased impedance caused by endotracheal tube obstruction as opposed to increased respiratory system impedance beyond the tip of tube. In t he second patient, in whom even a short interruption of ventilation wa s poorly tolerated, simultaneous rigid bronchoscopy (for removal of in tratracheal masses) and ventilation via endotracheal tube were success fully performed.