Tracheal Rupture due to Diffusion of Nitrous Oxide to Cuff of High-Volume, Low-Pressure Intubation Tube

Tracheal rupture is a rare complication of endotracheal intubation. Risk factors include short neck, repeated attempts due to failed intubation, inappropriate stylus, over-inflation of the cuff, poor positioning of the tube, inappropriate tube size, weakened membrane structure due to steroid use, chronic obstructive pulmonary disease, tracheomalacia, kyphosis, and use of nitric oxide during the operation. In this article, we suggest that high-volume, low-pressure tubes may not always provide a low-pressure effect and could rupture due to reduced tracheal perfusion pressure and ischemic damage upon over-inflation.