Failure to detect an unusual obstruction in a reinforced endotracheal tube with fiberoptic examination.

Obstruction of an endotracheal tube (ETT) is a potentially life-threatening event. We report an unusual obstruction of a reinforced ETT. The valve-like obstruction was caused by a partial detachment of the inner coating from the embedded spiral of the ETT. It led to an increase in inspiratory airway pressure, failure to detect end-expiratory CO(2), and generated a wheezing sound in forced expiration. Fiberoptic inspection, which is a recommended procedure for a suspected ETT-obstruction, failed to identify this detachment. Exchanging the defective ETT immediately resolved the critical clinical situation. The detachment was most likely caused by re-autoclavation of the ETT, which was a specified single-use product.