Tracheal rupture after tracheal intubation: effectiveness of conservative treatment.
A tracheal rupture is a rare complication of tracheal intubation. Risk factors include advanced age, COBP and corticosteroid therapy. The direct causes of the rupture are difficult tracheal intubation, particularly with a stylet inside the tube and overdistension of the cuff of the tracheal tube. The case of a 73-year-old woman with a tracheal rupture after an uncomplicated operation of a vaginal hysterectomy and bilateral adenexectomy is reported. The procedure of orotracheal intubation presented no difficulties. However, after 5 h the patient was presenting unexpected symptoms such as dyspnea and subcutaneous emphysema. After an inconclusive chest X-ray and chest TC, the diagnosis was made by emergency fiberendoscopy. We adopted a conservative treatment, consisting of a tracheal intubation and chest drain, which resulted in a full recovery after 5 days of mechanical ventilation. The causes that could have provoked a tracheal laceration in our patient and the suggested therapies with preference for conservative treatment, are discussed. We recommend a tracheal tube cuff monitoring during surgery, to prevent fatal overinflation of the cuff, which is permeable to nitrous oxide.
Moschini
V
V
Fondazione IRCCS Policlinico Mangiagalli, Regina Elena, Milan, Italy. vincenzomoschini@virgilio.it
Losappio
S
S
Dabrowska
D
D
Iorno
V
V
D000368:Aged; D015916:Drainage, Postural; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D007431:Intraoperative Complications / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D012421:Rupture; D014132:Trachea / Q000293:injuries*