title: Tracheal ring fracture during a PercuTwist tracheostomy procedure.
abstract: Because of difficult weaning from mechanical ventilation, a 59-yr-old man admitted for emergency cardiac surgery underwent a bedside PercuTwist tracheostomy on day 14 of his intensive care unit stay. We observed a double fracture of the second tracheal ring during the initial dilation process with the PercuTwist dilator, associated with distal migration of a cartilage fragment, which was avulsed from the anterior portion of the second cartilaginous ring.
  
  
  CONCLUSIONS
  Like other antegrade single-step techniques, the PercuTwist tracheostomy presents the risk of anterior tracheal wall damage during the initial stage of the dilation process. Antegrade forces applied to the trachea should be minimized by sufficiently deep skin incision and both slow and smooth initial rotation of the dilator.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Henri Mondor University Hospital and Paris XII School of Medicine, Créteil, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Scherrer
authors.forename: Loic
authors.initials: L
authors.lastname: Tual
authors.forename: Gilles
authors.initials: G
authors.lastname: Dhonneur
mesh_terms: D001980:Bronchi / Q000473:pathology; D002356:Cartilage / Q000293:injuries; D006801:Humans; D008297:Male; D008875:Middle Aged; D014132:Trachea / Q000293:injuries*; D014139:Tracheostomy / Q000009:adverse effects*; D015300:Ventilator Weaning