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Clinical Note
June 2012

Silicone-Based Endotracheal Tube Causing Airway Obstruction and Pneumothorax

Arch Otolaryngol Head Neck Surg. 2012;138(6):588-591. doi:10.1001/archoto.2012.688

Silicone-based endotracheal tubes (ETTs) may be prone to intraoperative airway obstruction. The Nerve Integrity Monitoring (NIM) ETT (Medtronic Xomed Inc) is one such tube, and it is used during thyroid and parathyroid surgery for intraoperative electromyographic recurrent laryngeal nerve monitoring. The NIM ETT uses bipolar stainless steel electrodes within the silicone-based tube, which contacts both vocal cords. The specialized tube also uses a silicone elastomer cuff to allow better tracheal conformity and minimal tissue trauma.1 The designed elasticity may predispose the silicone-based cuff to asymmetrically inflate at very high cuff pressures. While a review of the literature demonstrates a single case report of cuff herniation causing an obstruction of the distal ETT in a clinical situation, the Food and Drug Administration recognizes 8 other reported events.2 We report a similar case in which ventilation with the NIM ETT was impeded by a herniated cuff, resulting in high positive pressure ventilation and subsequent bilateral pneumothorax.