Rationale: Various factors can cause ventilatory failure after endotracheal tube (ETT) intubation, which is associated with increased patient morbidity and mortality.
Patient concerns: A 76-year-old woman who was diagnosed with a hemopericardium and suspicion of a major-vessel injury due to dislocation of the clavicular fracture fixation screw.
Diagnosis: Non-resterilized reinforced ETT obstruction caused by a structural defect.
Intervention: Endotracheal tube was exchanged.
Outcomes: The ventilator profile showed rapid improvement.
Lessons: Anesthesiologists should consider that a non-resterilized reinforced ETT may be defective. An ETT defect can cause high PIP and ETT obstruction without kinking or foreign materials.