A response to "stuck suction catheter in endotracheal tube".

Sir,

I read with interest the case report of the stuck suction catheter in endotracheal tube.[1] This is an unique case of unplanned extubation that is intentional and not accidental. Arterial oxygen desaturation is a known hazard associated with endotracheal suctioning. This is further aggravated if there occurs sudden loss of airway and ventilation following the act of suctioning. The proposed algorithm for management of stuck suction catheter in endotracheal tube (figure 3 of original article[1]) gives a comprehensive plan to manage the situation of the stuck suction catheter.

Most of the endotracheal suctioning is performed by paramedical staff in intensive care unit. So algorithm may include and emphasize maintenance of airway and ventilation of lungs by bag and mask in between loss of airway and intubation of the trachea. Bag mask ventilation may need to be continued a bit longer in patients with initial difficult intubation, so that availability of instruments and competent personnel can be ensured. Also laryngeal mask airway in abnormal patient positions like lateral decubitus position[2] and prone position[3] as a bridge device can be considered.