Preterm Baby Suffers Hypoxic Brain Injury After Mismanagement of Endotracheal Tube

Pediatrics Expert WitnessThis case involves a baby who was delivered in Arkansas preterm with respiratory distress. The child had been intubated, and initially did well, but started to have a period of apnea and oxygen saturation below normal. It is documented that at times the child’s oxygen saturation levels were as low as 60s. The patient was seen by a respiratory therapist who adjusted the endotracheal tube, but oxygen saturation only minimally improved. The ICU physician was eventually called, who then re-intubated the patient and his oxygen saturation improved significantly. However, the patient was found to have suffered an hypoxic brain injury.

Question(s) For Expert Witness

  • 1. What are methods that can be used to secure an ETT in the NICU setting?
  • 2. When a patient is hypoxic, what measures can be taken?

Expert Witness Response E-132391

I have been working in the NICU for about 10 years. In the NICU we use tape with Mastisol to secure the endotracheal tube or a commercial tube holder with tape. There is a variety of things that can be tried to improve the infant’s oxygen saturation. These include suctioning, (possibly bag saline suctioning for plugs if permitted by the hospital, surgeon, and physician) notifying the physician, arterial blood gas, vent changes, chest x-ray, adjusting the endotracheal tube and/or replacing the endotracheal tube. I’m a skilled Lifeflight NICU respiratory therapist and in-house NICU respiratory therapist.

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