Occlusion of the pilot tube in a Laser-Shield II endotracheal tube caused by methylene blue crystals: a case report

The Laser-Shield II (Xomed-Treace, Jacksonville, FL) endotracheal tube is equipped with methylene blue crystals to aid in the prompt detection of tube cuff rupture. As the tube cuff is being inflated with saline, the crystals are supposed to dissolve fully in the saline, forming a solution that is readily visible in the event of cuff rupture. We describe a case of occlusion of the pilot balloon tube caused by undissolved methylene blue crystals, a situation that made it impossible to deflate the Laser-Shield II tube cuff. Our experience may aid in future modification of endotracheal tube design.