title: [A post-intubation tracheal rupture in intensive care unit].
abstract: BACKGROUND
  Tracheal rupture is one of the most serious post-intubation complication. However, it is widely underestimated.
  
  
  METHODS
  An 86-year-old patient with a history of pancreas adenocarcinoma treated with gemcitabin was admitted in intensive care unit for an acute respiratory failure with no identified etiology. The worsening of her respiratory status required invasive mechanical ventilation. One laryngoscopy, performed by a trained operator, found a Cormack 1. Intubation was realized without stylet and the cuff inflated with a syringe. Hemodynamic instability, impaired gas exchange and an extensive subcutaneous emphysema occurred immediately. A CT-scan showed a supracarinal tracheal rupture.
  
  
  CONCLUSIONS
  The etiological analysis of this case identifies several causes of pars membranosa fragility, such as female sex, age greater than 50 years and the short stature. The emergency intubation and the cuff inflated by a syringe were the risk factors of tracheal rupture in this patient.
  
  
  CONCLUSIONS
  Special care should be paid to this complication, early diagnosis has probably a prognostic value. Training operators in the use of stylets and monitoring cuff pressure are required.
authors.affiliation: Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France.
authors.forename: K
authors.initials: K
authors.lastname: Bouattour
authors.affiliation: Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Prost-Lapeyre
authors.affiliation: Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Hauw-Berlemont
authors.affiliation: Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Diehl
authors.affiliation: Service de réanimation médicale, hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75908 Paris cedex 15, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France. Electronic address: emmanuel.guerot@egp.aphp.fr.
authors.forename: E
authors.initials: E
authors.lastname: Guérot
mesh_terms: D000369:Aged, 80 and over; D003422:Critical Care; D004632:Emergency Medical Services; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000150:complications / Q000628:therapy; D012421:Rupture; D013352:Subcutaneous Emphysema / Q000209:etiology / Q000628:therapy; D014132:Trachea / Q000293:injuries*
keywords: Cuff pressure; Emphysème sous-cutané; Eschmann stylet; Intubation; Lésion trachéale; Mandrin d’Eschmann; Pars membranosa; Pression ballonnet; Rupture trachéale; Subcutaneous emphysema; Tracheal injury; Tracheal rupture