title: Open Tracheostomy after Aborted Percutaneous Approach due to Tracheoscopy Revealing Occult Tracheal Wall Ulcer.
abstract: Tracheostomy is a common procedure for intensive care patients requiring prolonged mechanical ventilation. In this case report, we describe a 78-year-old female patient admitted for an aneurysm of the cerebral anterior communicating artery. Following immediate endovascular coiling, she remained ventilated and was transferred to the neurological intensive care unit. On postoperative day ten, a percutaneous tracheostomy (PCT) was requested; however, a large ulcer or possible tracheoesophageal fistula was identified on the posterior tracheal wall following bronchoscopic assessment of the trachea. Therefore, the requested PCT procedure was aborted. An open tracheostomy in the operating room was completed; however, due to the position and depth of the ulcer, a reinforced endotracheal tube (ETT) was placed via the tracheostomy. Four days later, the reinforced ETT was replaced with a Shiley distal extended tracheostomy tube to bypass the ulceration. Careful inspection and evaluation of the tracheostomy site before PCT prevented a potentially life-threatening issue in our patient.
authors: Florida Gulf to Bay Anesthesiology Associates, LLC, Tampa, FL 33606, USA ; University of South Florida, Department of Surgery, Tampa, FL 33606, USA.
authors: John
authors: J
authors: Schweiger
authors: Collin
authors: C
authors: Sprenker
authors: Devanand
authors: D
authors: Mangar
authors: Rachel
authors: R
authors: Karlnoski
authors: Naga
authors: N
authors: Pullakhandam
authors: Enrico M
authors: EM
authors: Camporesi
references: J Trauma. 1990 Apr;30(4):433-5
references: 2325175
references: J Postgrad Med. 2001 Apr-Jun;47(2):100-3
references: 11832598
references: Arch Surg. 1996 Feb;131(2):129-32
references: 8611067
references: J Am Coll Surg. 2013 Apr;216(4):858-65; discussion 865-7
references: 23403139
references: Intensive Care Med. 1994 Aug;20(7):476-9
references: 7995862
references: Intensive Care Med. 2002 Jan;28(1):59-62
references: 11819001
references: Chest. 2004 Sep;126(3):868-71
references: 15364768
references: Surg Infect (Larchmt). 2013 Feb;14(1):21-3
references: 23427790
references: Chest. 1996 Sep;110(3):762-6
references: 8797424
references: Intensive Care Med. 1997 Aug;23(8):859-64
references: 9310803
references: Chest. 1985 Jun;87(6):715-9
references: 3996056
references: Surgery. 1995 Nov;118(5):879-83
references: 7482276
references: Br Med J (Clin Res Ed). 1984 Mar 31;288(6422):965-8
references: 6423162
references: J Trauma. 2011 Dec;71(6):1553-6
references: 22182866
references: J Oral Maxillofac Surg. 2012 Jan;70(1):74-82
references: 21820231
references: Chest. 1995 Jun;107(6):1760-3
references: 7781382
references: J Am Coll Surg. 2011 Feb;212(2):163-70
references: 21193331
references: Chest. 2005 Dec;128(6):4050-1
references: 16354883
references: Chest. 2005 Nov;128(5):3774-5
references: 16304348
references: Intensive Care Med. 2013 Apr;39(4):575-82
references: 23160770