A Case of Massive Subcutaneous Emphysema and Pneumomediastinum Due to Dehiscence of Stoma After Emergent Tracheostomy

Abstract

Tracheostomy is commonly performed on patients who require long-term ventilator support. As with all other airway managements, tracheostomy comes with risks: tracheal scarring, tracheal rupture, pneumothorax, and tracheoesophageal fistula. Although rare, free air leakage into the surrounding tissues of the tracheostomy site and consequent pneumomediastinum can also occur due to various reasons, such as tracheal rupture and mispositioning of the tracheal tube. Such conditions may require treatments including high flow oxygen, ventilator management, and occasionally surgical intervention. In our case of a 61-year-old female, emergent tracheostomy was performed and subsequent complications of massive pneumomediastinum and subcutaneous emphysema were treated with negative pressure wound therapy. The follow-up radiograph after negative pressure wound therapy showed resolution of pneumomediastinum and subcutaneous emphysema, and there were no additional complications. Negative pressure wound therapy is an effective treatment option for massive pneumomediastinum and subcutaneous emphysema after tracheostomy.

A Systematic Review of Mortality Associations in Patients who Develop Tracheoinnominate Artery Fistula Following Tracheostomy

“…[3][4][5] Furthermore, an emergently performed tracheostomy has higher complication and mortality rates than an elective tracheostomy. 6 A tracheoinnominate artery fistula (TIF) is a specifically concerning complication, where an abnormal connection is formed between the innominate (brachiocephalic) artery and the trachea, and usually occurs more than 3 weeks postoperatively. 2,3,7,8 The incidence of TIF after tracheostomy is low, ranging from .1 to 1.0%.…”