An unusual case of cuff herniation.

We describe a case of herniation of an endotracheal tube with a high volume and low pressure cuff. In contrast with the conventional endotracheal tube with a low volume and high pressure cuff, which, after recognition of cuff herniation, can be deflated, the herniation of this type of tube could not be resolved in such a way. The large and soft cuff material had spread itself over the tube tip, as a result of the herniation and this was aggravated by deflation, making it impossible to adequately ventilate the patient. Pulse oximetry turned out to be a most helpful way of monitoring the seriousness of the situation, in which the patient was fully covered by sterile drapes.