Abnormally increased power of breathing as a complication of closed endotracheal suction catheter systems.

Tracheobronchial suctioning is an essential part of routine care for mechanically ventilated patients. Closed, rather than open, suction catheters are preferred for their advantages, which include minimizing risk of hypoxemia and containment of potentially infected secretions during suctioning.1,2 A closed-suction catheter is situated between the endotracheal tube (ETT) and the Y-piece of the breathing circuit, and thereby remains integrated in the circuit at all times. After suctioning, the catheter is retracted from the ETT into the suction catheter’s protective sleeve and is thus out of the airflow path to and from the ETT and breathing circuit. We report a case where the tip of a closed-suction catheter was inadvertently left in the tracheostomy tube, thereby increasing the patient’s work of breathing (WOB), evidenced clinically only by increased effort to breathe. Case Report