This page will look at medical malpractice cases involving negligent intubation and/or extubation, which is the insertion or removal of a breathing tube. We will also look at the settlement value of these cases.
The human body needs a constant flow of oxygen to survive. Normally we maintain oxygen supply by breathing – oxygen comes in and carbon dioxide goes out. When medical patients undergo surgery or certain other medical procedures they may not be able to breathe on their own. Airway Management refers to the medical procedures undertaken to prevent or relieve airway obstruction and ensure that a patient continues to breathe and receive oxygen when unable to do so on their own.
Intubation and Extubation
Tracheal intubation or “intubation” is an advanced airway management procedure in which a flexible breathing tube is inserted into the trachea (the “windpipe”) to prevent blockage and ensure airflow into the lungs. Intubation is accomplished non-surgically with an endotracheal tube that is routed through the mouth or through the nose and into the trachea. Once inserted the tube is usually hooked up to some sort of ventilation machine that pumps air in and out. There are also surgical methods of intubation the most common of which is called a tracheotomy. Surgical intubation is usually done for patients that will need prolonged airway management.
Intubation is a highly invasive procedure involving significant discomfort so it is preferably done only after the patient is given general anesthesia and/or a muscle relaxant. In emergency situations, however, intubation can be done with only local anesthesia. Intubation is often done with the aid of a laryngoscope which allows the doctor to see inside a patient’s throat to ensure accurate placement of the tube. Extubation refers to the process of removing the endotracheal breathing tube when it is no longer needed.
Extubation is the medical procedure for removing the endotracheal breathing tube from the patient’s airway. Extubation is a delicate procedure that must be done with care and proper technique, just like intubation. One of the big differences, however, is that extubation is usually not something that must be done immediately or on an emergency basis. Providers have more time to plan and schedule for extubation, which means we see fewer mistakes.
Intubation Malpractice and Injury
Intubation is a medical procedure that requires skill and training to perform. That being said, a properly trained and experienced doctor should be able to perform an intubation without harming the patient. When a patient is injured as a result of intubation or extubation it is commonly due to negligence on the part of the doctor. As a result, intubation injuries frequently lead to malpractice lawsuits. Intubation malpractice typically falls into one of the following categories: tube misplacement (tube is mistakenly inserted into esophagus); negligent delay; and tube dislodgement.
What makes intubation malpractice somewhat unique is that small mistakes can quickly result in very severe injury and even death. If the brain is deprived of oxygen even for a short time it can result in permanent brain damage or death.
The intubation procedure is usually performed by an anesthesiologist. The anesthesiologist is also the doctor that is directly responsible for monitoring the breathing tube after it is in place to make sure it does not become dislodged, etc. In most cases, however, intubation and airway management is a team effort so other doctors and hospital staff will also have some liability for intubation malpractice.
Common types of intubation malpractice include:
- Delayed Intubation: Failing to intubate a patient when necessary, which can lead to oxygen deprivation, respiratory failure, or cardiac arrest.
- Esophageal Intubation: Incorrectly placing the breathing tube in the esophagus instead of the trachea, which prevents oxygen from reaching the lungs and can cause hypoxia and brain injury.
- Improper Technique: Using incorrect positioning, force, or procedure during intubation, resulting in injuries to the mouth, throat, vocal cords, or trachea.
- Failure to Monitor Oxygen Levels: Not monitoring a patient’s oxygen saturation levels during intubation or after placement, leading to undetected hypoxia.
- Inadequate Patient Assessment: Failing to assess patient anatomy or underlying conditions that may complicate intubation, increasing the risk of trauma or failed intubation.
- Lack of Proper Equipment: Failing to have or use the appropriate intubation tools, which may lead to delays, repeated attempts, or improper tube placement.
Extubation Malpractice and Injury
Extubation malpractice refers to errors or negligence occurring during the removal of a breathing tube (extubation) that results in patient harm. Extubation is a complex and sensitive process typically performed after surgery or prolonged intubation when the patient can breathe independently. However, complications from improper extubation techniques can be serious, leading to conditions such as brain damage, respiratory failure, cardiac arrest, or even death.
Some common causes of extubation malpractice include:
- Premature Extubation: Removing the breathing tube before the patient can reliably breathe on their own, which may result in respiratory distress or oxygen deprivation.
- Improper Assessment: Failing to evaluate a patient’s readiness for extubation, including factors like muscle strength, lung function, and neurological status.
- Inadequate Monitoring: Not closely observing the patient post-extubation for any signs of distress or difficulty, which can lead to delayed response to critical complications.
- Inappropriate Extubation Technique: Errors in technique or protocol during the extubation process, leading to trauma, bleeding, or aspiration.
- Poor Communication: Failure in communicating extubation timing or patient status among the medical team, leading to insufficient preparation or support.
Legal cases in extubation malpractice typically involve proving that the medical provider deviated from accepted standards of care and that this negligence directly caused the patient’s injury. Expert testimony often plays a significant role in establishing whether proper protocols were followed and in determining if the injury was preventable.
Settlements & Verdicts
We have not seen many airway management verdicts and settlements in Maryland and confidentiality rules prevent us from being about to provide results in many of our cases. Here are a few recent verdicts and settlement in extubation and intubation cases around the country.
- Virginia (2024) $600,000: A 17-year-old boy with congenital heart disease died from respiratory distress leading to cardiac arrest shortly after extubation. Wrongful death lawsuit alleged that the defendant failed to properly wean the minor off of ventilator support, failed to allow a sufficient amount of time for removal from the ventilator and that the treating respiratory therapists failed to discourage and advocate against extubation, given the decedent’s status of distress, increased work-of-breathing and potential for extubation failure.
- New York (2024) $1.6 million: The plaintiff reportedly was intubated by a resident with the assistance of an attending physician. The plaintiff reportedly experienced traumatic intubation and tracheostomy tube dependence, leading to multiple voice, throat and respiratory problems. The plaintiff allegedly suffered nerve damage, laryngeal nerve damage, vocal fold/cord paralysis and/or paresis, respiratory distress, dysphagia, and pneumonia. The plaintiff’s assertions of medical malpractice included allowing prolonged intubation, failing to appreciate risks associated with prolonged intubation, failing to properly and timely extubate, failing to properly and timely perform a tracheotomy, causing/permitting reintubation, and causing/allowing nerve damage.
- Florida (2024) $31.9 million: The decedent died from loss of oxygen after it took hospital staff and defendant doctor over 14 minutes to intubate him. The lawsuit alleged that the defendants were negligent in failing to perform an appropriate airway assessment, failing to use a laryngeal mask airway or open an emergent surgical airway once initial intubation attempts failed, allowing for multiple repeated intubations to be performed on him, failing to have an intensivist, hospitalist, or intensive care nurse in attendance, failing to have the necessary equipment for intubation.
- Pennsylvania (2023) $14 million: The decedent, a 4-year-old boy, went to the hospital with pneumonia. It was determined that the boy needed to be intubated. Multiple intubation attempts were made but no intubation tubes reportedly ever entered S.M.’s trachea and instead entered his esophagus. He died of respiratory failure.
- New Jersey (2018) $17 million: in this case a 7 year patient was intubated during surgery. After the surgery the doctors removed the breathing tube (extubation) prematurely and the patient was not able to breath on her own once the tube was removed. She suffered permanent brain damage as a result and would require assistance the rest of her life. The doctors were found negligent because they only did a cursory 10 min test to ensure the patient was able to breathe before the extubation when the standard of care called for 30 min to 2 hours. A jury in Monmouth County, New Jersey awarded the plaintiff $17,000,000.
- Illinois (2017) $3 million: in this case a patient at a Chicago hospital died on the operating table when his breathing tube became dislodged during the surgery. The suit alleged that the doctors were negligent in failing to properly perform the intubation and then failing to properly monitor and maintain the breathing tube during the surgery allowing it to dislodge. The case was settled for $3,000,000.
- New York (2017) $435,000: the 54-year old plaintiff in this case was intubated for liver transplant surgery at Presbyterian Hospital in New York. He filed suit claiming that he suffered a stroke and vocal cord damage because the hospital was grossly understaffed and failed to properly monitor and maintain his breathing tube and ventilator. A jury awarded $435,000.
- Pennsylvania (2017) $1 million: in this case the hospital and doctors needed to perform an emergency intubation on a 23 year patient. They were not prepared with the required equipment to respond fast enough and by the time the doctors performed the intubation and obtained an open airway the patient had already died. The suit filed in Philadelphia alleged negligent delay in intubation and was eventually settled for $1,000,000.
Contact Us About Intubation or Airway Management Malpractice
If you or someone you know may have been injury in connection with negligent intubation or airway management, contact our office at 1.800.553.8082 or submit a request for a free consultation.