Scenario: You intubated 53 year old short female * without any complication. CXR showed ETT in right main stem. You instructed RT (Resp. Therapist) to pull ETT by 3 cm. After adjustment, patient develop significant SQ emphysema along with periorbital swelling.
Answer: Tracheal tear due to repositioning of the tube without cuff deflation !
Tracheobronchial laceration is a potential serious complication of endotracheal intubation. It can occur following uneventful intubation. Most injuries are in the lower third of the trachea .
Most common causes include:
- Overinflation of the cuff, resulting in necrosis of the mucosa after prolonged intubation
- Repositioning of the tube without cuff deflation
- Patient movement
- A sudden increase in the intratracheal pressure caused by vigorous coughing in the presence of the endotracheal tube
- Inappropriate tube size
- COPD
- Conditions associated with a weakness of the membranous trachea (eg, elderly patient, steroid therapy)
- Mucosal erosion or perforation of the anterior cartilaginous tracheal wall from the tip of the tube or the stylet.
* Almost all cases of postintubation tracheal laceration are reported in short female patients.
Reference: Click to get article/abstract
1. A 63-Year-Old Woman With Subcutaneous Emphysema Following Endotracheal Intubation - Chest. 2005;128:434-438
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