Skip to main content

A piece of broken intubation tube stylet as endobronchial foreign body

Abstract

Endotracheal tube stylets are still being used in many medical centres for difficult intubations. In rare cases, it may break inside the trachea during endotracheal intubation and may sometimes move unnoticed deep into the tracheobronchial tree. In this case report, the authors describe a rare complication after endotracheal tube (ETT) stylet intubation in a patient in whom a broken piece of metal guide remained in her tracheobronchial tree. A 69-year-old lady was admitted to our hospital for management of shortness of breath and cough with expectoration. The patient was a known case of chronic obstructive pulmonary disease, cor pulmonale and coronary artery disease. The authors report a case of an unrecognized broken piece of stylet in her tracheobronchial tree and left main bronchus, which was later detected by computed tomography scan and extracted. Despite precise evaluation before use, signs of breakage in the stylet may be missed, and, consequently, it may break inside the trachea and result in serious complications. It is strongly recommended that the intensivists pay attention to the sounds and movements of the instruments.

References

  1. Modir H, Moshiri E, Malekianzadeh B, Noori G, Mohammadbeigi A. Endotracheal intubation in patients with difficult airway: using laryngeal mask airway with bougie versus video laryngoscopy. Med Gas Res 2017; 7:150–155.

    Article  CAS  Google Scholar 

  2. Driver BE, Prekker EM, Klein RL, Readron FR, Miner RJ, Fagerstrom TE, et al. Effect of use of a bougie vs endotracheal tube and stylet on first-attempt intubation success among patients with difficult airways undergoing emergency intubation: a randomized clinical trial. JAMA 2018; 319:2179–2189.

    Article  Google Scholar 

  3. Brown CA, Bair AE, Pallin DJ, Walls RM, et al. Techniques, success, and adverse events of emergency department adult intubations. Ann Emerg Med 2015.

  4. Fathi M, Farzange B, Mojtabaee M, Nikzamir A. A piece of broken metal from intubation stylet retained in tracheobronchial tree a case report. Tanaffos 2014; 13:51–54.

    PubMed  PubMed Central  Google Scholar 

  5. Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology 2013; 118:251–70.

    Article  Google Scholar 

  6. Boyd RL, Bradfield HA, Burton EM, Carter BS. Fluoroscopyguided retrieval of a sheared endotracheal stylet sheath from the tracheobronchial tree in a premature infant. Pediatr Radiol 1999; 29:575–7.

    Article  CAS  Google Scholar 

  7. Shetty S, Power S, Afshar K. A sheared stylet. BMJ Case Rep 2010; 2010: bcr0220102725.

  8. Sharma A, Jain V, Mitra JK, Prabhakar H. A rare cause of endotracheal tube obstruction: a broken stylet going unnoticed –a case report. Middle East J Anaesthesiol 2008; 19:909–11.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Asmita A. Mehta MD.

Additional information

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shafi, T.M., Haridas, N., Belagundi, P. et al. A piece of broken intubation tube stylet as endobronchial foreign body. Egypt J Bronchol 13, 774–777 (2019). https://doi.org/10.4103/ejb.ejb_52_19

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ejb.ejb_52_19

Keywords