A defective endotracheal tube.

Routine inspection and testing of endotracheal tubes prior to use may fail to detect certain manufacturing defects. We describe a case of endotracheal tube kinking at the junction where the inflation tube for the pilot balloon is attached to the endotracheal tube. This case report highlights the importance of maintaining an awareness that airway obstruction or leak due to structural defects can still occur even with high quality, prepacked single use plastic endotracheal tubes. It also emphasises the need to have a systematic approach when dealing with such critical events.