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July 3, 1981

Fatal Hemorrhage From Airway Tube Tip

JAMA. 1981;246(1):40. doi:10.1001/jama.1981.03320010022016

To the Editor.—  The hospital course of a comatose 17-year-old boy is a reminder that the advent of the highvolume low-pressure (HVLP) cuffed airways has not eradicated the potential for fatal intratracheal hemorrhage owing to tube tip erosion of tracheal mucosa.1 The tube-tip-induced erosions should not be confused with the erosions of mucosa with intratracheal hemorrhage due to the cuffs of the older-style airways.2When the patient was weaned from the respirator, the airway cuff was deflated to avoid further mucosal erosion by the cuff. The HVLP cuffed airway, however, was kept in place because (1) the stem of the tube would keep the tracheostomy stoma from closing up in case controlled mechanical ventilation again became necessary, and (2) it was conjectured that, should vomiting occur, the cuff could be reinflated quickly and aspiration prevented. Two days later pink aspirate appeared. Within a day it was followed by