A 49-kg female patient intubated with a size 7 mm inner diameter (ID) endotracheal tube is being mechanically ventilated in the volume-controlled continuous mandatory ventilation (VC-CMV) mode
During patient rounds, both the low-pressure and low-volume alarms are sounding persistently on the ventilator. Upon observation of the patient, the respiratory therapist hears murmuring from the patient, with audible sounds during inspiration. The cause of this condition is which of the following?
a. Circuit leak
b. Endotracheal tube (ET) cuff leak
c. Circuit disconnection
d. Incorrect ET tube size
ANS: B
If a leak is present during a positive-pressure breath, air can be heard escaping from the patient's mouth. If there is a large enough leak, the ventilator's low-pressure and low-volume alarms will sound. A circuit leak or disconnection would cause the low alarms to sound but not cause the leak around the endotracheal tube cuff. An incorrect endotracheal tube may cause a leak around the cuff. However, a size 7 mm ID is appropriate for this particular size patient.
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