Kinking of an endotracheal tube resulting in barotrauma

A 55-year-old female was endotracheally intubated and placed on mechanical ventilation for acute respiratory distress syndrome associated with severe pancreatitis. High airway pressures were noted and barotrauma with left-sided pneumothorax required placement of a thoracostomy tube. Difficulty passing the in-line suction catheter was noted. The patient was extubated and re-intubated. The original endotracheal tube was found to have a large kink that greatly narrowed its diameter.