title: Bronchial selective ventilation in a wide tracheocutaneous fistula.
abstract: We present the treatment and management of a wide tracheocutaneous fistula after tracheotomy correlated with excessive cuff pressure in a 36-year-old woman with cerebral palsy since infancy in which persistent type II respiratory failure required continuous ventilatory support. We discuss the surgical treatment adopted for the management of this particularly wide lesion. At the end of surgery, mechanical ventilation through a tracheal cannula was hindered by the reduced length of the residual trachea below the tracheotomy. The need to guarantee mechanical ventilation to the patient led to the implementation of a cuff securing system in the two main bronchi. We describe the approach that may be attempted under extreme conditions, when traditional ventilation methods cannot be applied for anatomical reasons.
authors.affiliation: Respiratory Disease Clinic, University Hospital Modena, Italy ; ENT Department, University Hospital Modena, Via Del Pozzo 71, 41100 Modena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Marchioni
authors.affiliation: ENT Department, University Hospital Modena, Via Del Pozzo 71, 41100 Modena, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Mattioli
authors.affiliation: ENT Department, University Hospital Modena, Via Del Pozzo 71, 41100 Modena, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Piccinini
authors.affiliation: ENT Department, University Hospital Modena, Via Del Pozzo 71, 41100 Modena, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Marchioni
authors.affiliation: ENT Department, University Hospital Modena, Via Del Pozzo 71, 41100 Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Alicandri-Ciufelli
authors.affiliation: Respiratory Disease Clinic, University Hospital Modena, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Monelli
authors.affiliation: ENT Department, University Hospital Modena, Via Del Pozzo 71, 41100 Modena, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Presutti
keywords: Bronchial intubation; Tracheocutaneous fistula; Ventilation