This case report presents a rare case of a mechanical ventilation leak that was initially missed by clinicians in a patient with a myxoedema coma. Despite all efforts to investigate the causes of the leak, including a bedside lung ultrasound and chest radiograph, the leak persisted. It was eventually discovered that the rhythmic inflation and deflation of the polythene covering the closed suction system was causing the leak. The closed suction system was replaced with a new one, and the tidal volume was restored, resulting in the resolution of the leak alarm. The volume leak alarm and low volume alarm are important indicators of potential problems during mechanical ventilation, and close suction system malfunction is a potential cause of volume leak that should be considered in mechanically ventilated patients. Regular monitoring and appropriate management of these alarms and potential causes can help prevent complications and optimize patient care. Keywords: Mechanical ventilation, volume leak alarm, closed suction system, and myxoedema coma.

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