A fatal complication of tracheostomy cannula exchange: Bilateral pneumothorax, pneumomediastinum, and subcutaneous emphysema

Yıl 2024, Cilt: 15 Sayı: 3, 71 - 73, 22.09.2024

Fatih Çatal

https://doi.org/10.33706/jemcr.1519281

Öz

Introduction: Although tracheostomy opening or replacement is generally a safe procedure, it carries varying risks of complications. Serious complications include false lumen formation between tissues surrounding the trachea, tracheal posterior wall damage, bleeding, pneumomediastinum, pneumothorax, and death. The incidence of these complications increases especially in patients who are obese, have a short neck or anatomical deformity.
Case Report: A 24-year-old male patient was brought to the emergency department with respiratory distress. His family stated that his complaints started four days ago after the change of the tracheostomy cannula in a hospital. Computed tomography of the neck and chest revealed subcutaneous emphysema in the neck and anterior chest, free air between deep tissues in the neck, pneumomediastinum and bilateral pneumothorax. Supportive oxygen therapy was started and the patient was consulted for thoracic surgery. After tube thoracostomy of the right hemithorax, intensive care unit hospitalization was performed. The patient died on the 25th day of intensive care unit hospitalization due to type 2 respiratory failure.
Conclusion: In patients with tracheostomy presenting to the emergency department with dyspnea, cannula-related causes should also be considered in the differential diagnosis.

Anahtar Kelimeler

Bilateral pneumothorax, Tracheostomy, Complication, Subcutaneous emphysema, Pneumomediastinum

Kaynakça

• 1. Bontempo LJ, Manning SL. Tracheostomy Emergencies. Emergency Medicine Clinics of North America. 2019 Feb;37(1):109–19.
• 2. Spiller P, Dewan K, Kost KM, Nathan C. Established Adult Tracheostomy Tube Exchange: How Often is Enough? The Laryngoscope. 2024 Jan 8;lary.31252.
• 3. Saeed S, Alothman S, Safavi A, Donaldson B, Ramcharan A, DePaz H. Tracheostomy Exchange Resulting in Rare Combination of Pneumomediastinum, Pneumothorax, Massive Pneumoperitoneum, and Subcutaneous Emphysema. Cureus [Internet]. 2017 Jul 18 [cited 2024 Mar 3]; Available from: http://www.cureus.com/articles/7761- tracheostomy-exchange-resulting-in-rare-combinationof- pneumomediastinum-pneumothorax-massivepneumoperitoneum- and-subcutaneous-emphysema
• 4. Shetty N, Manjunath P, Anjilivelil D, Iyer S. Light at a tunnel'send: The lightwand as a rapid tracheal locationaid when encountering false passage during tracheostomy. Indian Journal of Critical Care Medicine. 2010 Jul 1;14(3):144– 6.
• 5. DeVos E, Jacobson L. Approach to Adult Patients with Acute Dyspnea. Emergency Medicine Clinics of North America. 2016 Feb;34(1):129–49.
• 6. Przybylo JA, Wittels K, Wilcox SR. Respiratory Distress in a Patient with a Tracheostomy. The Journal of Emergency Medicine. 2019 Jan;56(1):97–101.
• 7. Engels PT, Bagshaw SM, Meier M, Brindley PG. Tracheostomy: from insertion to decannulation. 2009;52(5).
• 8. Kwon MA, Cho C, Park JH. Life-threatening tension pneumothorax after unsuccessful tracheostomy tube exchange in a trauma patient - A case report -. Anesth Pain Med. 2020 Jan 31;15(1):124–8.
• 9. Khandelwal A, Kapoor I, Goyal K, Singh S, Jena BR. Pneumothorax during percutaneoustracheostomy - a brief review of literature on attributablecauses and preventablestrategies. AnaesthesiolIntensiveTher. 2014 Aug4;VM/OJS/J/51062.
• 10. Garg SK, Garg P, Anchan N, Jaiswal A. Iatrogenic Bilateral SimultaneousPneumothorax: Call for Vigilance. IndianJournal of Critical Care Medicine : Peer-reviewed, OfficialPublication of Indian Society of Critical Care Medicine. 2017 Sep;21(9):607.
• 11. Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, editors. Tintinalli’s emergency medicine: a comprehensive study guide. Ninth edition. New York: McGraw-Hill Education; 2020. 2114 p.
• 12. Kim WH, Kim BH. Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy -A case report-. Korean J Anesthesiol. 2012;62(5):488.