Unanticipated endotracheal tube displacement in a short-neck patient with a history of chronic rheumatoid arthritis: a comparison of three kinds of endotracheal tubes

Endotracheal tubes are known to have a risk of being displaced at neck extension or flexion or rotation. However, the displacement seldom causes clinical problems. An 74-year-old patient suffering from chronic rheumatoid arthritis underwent debridement in the infected knee under general anesthesia. Mechanical ventilation had to be continued because of poor oxygenation after the operation. She had been intubated with Hi Lo Evac endotracheal tube (HLE) for 3 days, then extubated. However, she again needed mechanical ventilation because of aggravated oxygenation. At that time, Profile cuff siliconised endotracheal tube (PCS) was placed for 3 days. We encountered dangerous displacement of HLE during the first mechanical ventilation, but did not have any clinically dangerous displacement of PCS during the second mechanical ventilation. Therefore, we compared the hardness of the three popular endotracheal tubes. We found the hardness of HLE was higher than the others. This might be one of the reasons for dangerous displacement of the endotracheal tube in our case.