Monday, October 22, 2007

Monday October 22, 2007


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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