Background

Endotracheal intubation (ETI) is a routine procedure in the operating room and the Pediatric Intensive Care Unit (PICU) with frequent use of a stylet to facilitate successful intubation. Stylets are covered with a plastic sheath to prevent airway trauma and to assure easy removal of the stylet after intubation however the use of stylets has its complications.

Objectives

To raise awareness to a serious immediate complication of ETI using a stylet.

Methods

Case presentation and literature review.

Results

A 5 weeks old male baby suffering from severe cardiac failure due to myofibromatosis underwent intubation and anesthesia for tunneled central venous catheter insertion. In the pediatric intensive care unit, chest X-Ray revealed an elongated foreign body in the right main bronchus. When removed by the otolaryngologists, the foreign body was confirmed to be a severed tip of the stylet's plastic sheath. Sadly the patient passed away during the removal due to cardiac failure.

Reviewing the literature we found 16 case reports of stylet related complications of which 8 were neonates and premature babies and 8 adults. All cases required further invasive intervention to resolve endotracheal tube (ETT) or airway obstruction. A recent survey among neonatologists revealed that up to 3% personally experienced or witnessed a stylet breakage resulting in ETT occlusion or foreign body aspiration.

Conclusion

Retained sheared stylet plastic sheath causing airway obstruction is a rare ETI complication. Physicians should be aware of this complication hence, verify the stylet is complete upon removal. This potential complication should be emphasized in teaching ETI procedure.