A man admitted to a hospital in Brazil after being struck by a car was comatose and developed respiratory failure. He was intubated and mechanically ventilated, with resultant improvement of blood gases and vital signs. After two days his orotracheal tube was changed because of the presence of thick secretions. Three hours later he developed acute respiratory failure and cardiac arrest and could not be resuscitated. Postmortem examination revealed a long roundworm (Ascaris lumbricoides) in the endotracheal tube. The roundworm is common in tropical areas and infests the bodies of many human beings. Larvae ingested with food, water, and dust become worms in the human host and may migrate to various parts of the body. In this instance the roundworm may have been in the pharynx at the time of reintubation and then entered and obstructed the endotracheal tube. (Imbeloni LE. Fatal Obstruction of an Endotracheal Tube by an Intestinal Roundworm. Respir Care 1984;29:368-370.
