Intubation is a medical procedure that’s routine in hospital settings. It involves placing a plastic breathing tube through a patient’s mouth down into the trachea (windpipe) to secure the airway. Successful intubation ensures that there’s no obstruction that prevents the patient from being able to breathe and ventilate.
Emergency physicians and pulmonologists perform intubations in the emergency room (ER) when patients arrive unconscious or having a seizure. In the operating room, anesthesiologists or certified registered nurse anesthetists (CRNAs) intubate patients before surgery when general anesthesia will be used.
Whether done in an emergency or planned setting, there are safety rules that health care providers are required to follow to guard against dangerous errors and complications, such as esophageal intubation.
Esophageal intubation
Esophageal intubation is a serious mistake and complication of an intubation attempt. It happens when a doctor or CRNA misses the trachea and instead inserts the tube through the esophagus. The trachea is the windpipe at the very front of the neck. The esophagus is the muscular structure behind the trachea that’s the route for food and water to get to the stomach.
Of course, ramming a breathing tube down the esophagus won’t do anything to help a patient breathe. If the provider doesn’t recognize the improper intubation quickly, the oxygen supply to the patient gets cut off, which can lead to a permanent brain injury.
To avoid this type of tragic outcome, the standard of care requires anesthesiologists, CRNAs, and other providers to evaluate the patient for exhaled carbon dioxide after the breathing tube is inserted. Specifically, capnography monitoring allows instant analysis of end-tidal carbon dioxide (CO2) in exhaled air. If there’s no end-tidal CO2, that’s evidence of a significant problem requiring immediate evaluation to check for esophageal intubation.
If the doctor figures out that he put the tube in the wrong hole, it requires immediate extubation (removal of the breathing tube from the esophagus) and placing a breathing tube into the trachea to secure the patient’s airway.
As an experienced Houston, Texas medical malpractice lawyer, our firm carefully investigates the possibility of esophageal intubation when a patient dies or is left with a permanent brain injury because of poor anesthesia or intubation care. Some factors that we analyze in such cases include:
• The identity of who performed the intubation and that provider’s level of training and experience.
• Whether the hospital or ambulatory surgery center had capnography equipment available to measure end-tidal carbon dioxide after intubation, and if it was working properly.
• Whether the providers utilized capnography and, if so, if they interpreted the results correctly.
Esophageal perforation
Trauma to the esophagus is another concern when an anesthesiologist, CRNA, surgeon, or other physician misses the trachea and inserts a breathing tube into the esophagus by mistake. In some cases, the trauma causes perforation of the esophagus.
According to medical literature, a perforated esophagus has a mortality, or death, rate of over 20%. That’s because cases of esophageal perforation are sometimes misdiagnosed, leaving patients to develop a fast-growing infection that turns into a system-wide inflammatory response called sepsis, which in turn causes multiple organ failure.
If you’ve experienced a serious injury or wrongful death because of poor intubation or anesthesia care, then I encourage you to contact a top-rated experienced Houston, Texas medical malpractice attorney for help in evaluating your potential case.
