Missed Diagnosis Endotracheal Malfunction Causing Air Way Obstruction

This case report highlights a scenario of recurrent respiratory distress in a critically ill patient initially attributed to bronchospasm or delirium but ultimately diagnosed as endotracheal tube cuff malfunction obstructing the tracheostomy tube.A 33-year-old male with a history of generalized body swelling, decreased urine output, and respiratory symptoms presented to the emergency department.Despite initial management, including non-invasive ventilation and antibiotics for suspected sepsis, the patient's condition deteriorated, requiring intubation and transfer to the intensive care unit.After 21 days of Intensive care unit admission and tracheostomy placement, the patient experienced sudden-onset respiratory distress post-tracheostomy.Despite multiple evaluations, the mechanical complication of a distended cuff obstructing the tracheostomy tube was missed initially, leading to recurrent episodes of respiratory distress.Following successful identification and replacement of the tracheostomy tube, the patient's symptoms resolved, emphasizing the importance of maintaining a high index of suspicion for mechanical complications in critically ill patients.This case underscores the need for a systematic approach to evaluating respiratory distress and highlights the value of interdisciplinary collaboration in critical care management.