title: Safety of performing percutaneous dilational tracheostomy in patients with preexisting barotrauma.
abstract: Since its introduction in 1985 by Ciaglia et al, percutaneous dilational tracheostomy (PDT) has gradually become the procedure of choice in establishing a long-term airway in many intensive care units (ICU). However, the safety of performing PDT in patients with barotrauma is still unknown and has never been reported. We present the case of a 35-year-old man with AIDS, who was admitted to our medical ICU for pneumonia and acute respiratory distress syndrome. He developed subcutaneous emphysema and pneumomediastinum as complications of mechanical ventilation. After stabilization of the barotrauma, he underwent PDT with the standard Ciaglia Blue Rhino technique. However, rapid and extensive progression of preexisting barotraumas occurred shortly after PDT. This severe complication was nearly fatal. The prolonged procedure during which the susceptible lung was exposed to longer duration of high airway pressure was thought to be the mechanism of rapid deterioration of the preexisting barotrauma. With aggressive supportive care, the patient survived. To prevent further deterioration of preexisting barotraumas during and after PDT in future cases, we propose some principles that should be strictly followed. Under administration of these principles, we safely performed PDT in another case with preexisting barotrauma 1 month later.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chau-Chyun
authors.initials: CC
authors.lastname: Sheu
authors.forename: Jong-Rung
authors.initials: JR
authors.lastname: Tsai
authors.forename: Meng-Hsuan
authors.initials: MH
authors.lastname: Cheng
authors.forename: Inn-Wen
authors.initials: IW
authors.lastname: Chong
authors.forename: Ming-Shyan
authors.initials: MS
authors.lastname: Huang
authors.forename: Jhi-Jhu
authors.initials: JJ
authors.lastname: Hwang
mesh_terms: D000328:Adult; D001469:Barotrauma / Q000150:complications*; D006801:Humans; D008297:Male; D012449:Safety; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*