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Uncontrollable bleeding is the major cause of possible preventable death after traumatic injury. Up to one third of patients admitted to the emergency room will develop the so-called trauma induced coagulopathy (TIC) which has been shown to be associated with massive transfusions, increased morbidity and mortality. Several recent studies contribute to our present understanding of the pathophysiological mechanisms of TIC.

Purpose: To present a case of laryngeal damage in an infant caused by a too large and inappropriately designed cuffed tracheal tube. Clinical features: A 13-month-old child undergoing cardiac surgery was intubated with an uncuffed endotracheal tube with an internal diameter (ID) of 4.0 mm. Because of an important air leak around the tracheal tube during mechanical ventilation, a cuffed endotracheal tube lD 4.0 mm was inserted. The air leak with the tube cuff not inflated was acceptable at 25 cm H2O airway pressure. After extubation on the third postoperative day the patient showed increasing stridor and respiratory deterioration. Fibreoptic laryngoscopy of the spontaneously breathing patient showed a large intra-laryngeal web. After surgical removal of the web, the child rapidly recovered and was discharged from the hospital on the 12th postoperative day. Conclusion: The larger than expected tracheal tube with its intralaryngeal cuff position in a 13-month-old child likely caused mucosal damage and an inflammatory reaction within the larynx resulting in granulation tissue formation and fibrous healing around the tracheal tube.