Acute airway obstruction as a result of minitracheotomy

Campbell, Alison M.; O’Leary, Anthony M.

doi:10.1111/j.1365-2044.1991.tb09600.x

Cited by 11 publications

(5 citation statements)

References 12 publications

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“…Airway obstruction caused by the presence of blood clot has been noted as a complication of bronchiectasis, 5 tuberculosis, 3,4,6 mitral stenosis, 7-9 pulmonary infarction, 10,11 pulmonary arteriovenous malformation, 1,5 sarcoidosis, 12 bronchial carcinoma, 13 and intrathoracic trauma 2,14 (Table 1). Mucosal damage from suction catheter manipulation, 18 bronchoalveolar lavage, 12 transbronchial biopsy, 19,20 and tracheostomy placement [21][22][23] have also led to airway blood clots. Although a recent history of endobronchial bleeding can alert the clinician to the possibility of such an event, approximately 30% of the cases reported in the literature had no evidence of preceding hemoptysis.…”

Section: Discussionmentioning

confidence: 99%

Successful Treatment of Pulmonary Lymphangioleiomyomatosis With Progestins

Denoo¹,

Hermans²,

Degives

et al. 1999

Chest

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Section: Discussionmentioning

confidence: 99%

Successful Treatment of Pulmonary Lymphangioleiomyomatosis With Progestins

Denoo¹,

Hermans²,

Degives

et al. 1999

Chest

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“…A complication rate of 16% was reported [5] and difficulty on insertion was encountered in 54% of cases [6]. A Seldinger technique for insertion was advocated in an attempt to reduce [7] complications which may include bronchospasm, mediastinal puncture, paratracheal entrance of the cannula, subcutaneous emphysema [6] bleeding, which may be life threatening [8], oesophageal perforaÍtion [9], pneumothorax [10], acute airway obstruction [11] and ossification of the cricothyroid membrane [12].…”

Section: Discussionmentioning

confidence: 99%

An unusual complication of minitracheostomy

1999

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A 72-year-old woman had a minitracheostomy inserted for sputum retention. This was undertaken by a relatively junior resident who opted to use an early model minitracheostomy kit Minitrach II. The following day the patients condition deteriorated and intubation was warranted, at which time it was apparent to senior staff that the minitracheostomy had been malpositioned. Ten days later, formal tracheostomy was performed under general anaesthesia. After incision, an abscess in the thyroid gland was found. Histology subsequently revealed a Hurthle cell tumour of the thyroid. Thyroid abscess is exceedingly rare. It typically occurs in abnormal thyroid tissue and with a focus on infection. The combination of Hurthle cell adenoma and a foreign body (the minitracheostomy) was evidently causative in this instance. This complication of minitracheostomy insertion has not to our knowledge, previously been reported.

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“…Its utility in other situations, including an acute care setting, remains unclear [ 7 ]. Although an MT is considered less invasive and more easily performable than conventional tracheostomy, it carries the risk of a number of complications [ 3 – 5 ]. Catastrophic airway obstruction due to clotting has been reported, but in most cases, this has occurred during or immediately after insertion of an MT tube [ 4 , 5 ].…”

Section: Case Presentationmentioning

confidence: 99%

“…Although an MT is considered less invasive and more easily performable than conventional tracheostomy, it carries the risk of a number of complications [ 3 – 5 ]. Catastrophic airway obstruction due to clotting has been reported, but in most cases, this has occurred during or immediately after insertion of an MT tube [ 4 , 5 ]. Late bleeding after MT tube insertion can therefore be considered a rare occurrence: indeed, in one case, the latest bleeding time was reported as occurring at approximately 38 h after insertion of an MT tube [ 8 ].…”

Section: Case Presentationmentioning

confidence: 99%

“…It is usually performed in an operating room or intensive care unit (ICU). Although considered less invasive than an open tracheostomy, an MT carries the risk of complications, including malposition, disposition, bleeding, subcutaneous emphysema, and delayed healing [ 3 – 5 ]. Meanwhile, airway trouble is a major cause of death in the ICU [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Lower airway obstruction due to a massive clot resulting from late bleeding following mini-tracheostomy tube insertion and subsequent clot removal and re-intubation

et al. 2017

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BackgroundEasier to perform than the conventional procedure, mini-tracheostomy (MT) is widely used in the operating room or intensive care unit to remove sputum or other obstructions of the upper airway. This option, however, does carry the risk of various complications, including malposition, disposition, bleeding, and subcutaneous emphysema. Here, we report a case of endotracheal tube obstruction due to a massive clot resulting from late bleeding around the insertion site of an MT tube. This necessitated removal of the endotracheal tube together with the clot followed tube re-introduction.Case presentationThe patient was an 85-year-old man in whom an MT tube had been inserted 6 days earlier following aortic replacement surgery. On re-admittance to our intensive care unit, large amounts of hemosputum and clotting were observed around the insertion site of the tube. The MT tube was subsequently removed and tracheal intubation performed. Ventilation via the endotracheal tube proved impossible, however, and cardiac arrest ensued. Fiberoptic bronchoscopy revealed that the endotracheal tube was completely obstructed by a massive clot. Therefore, we immediately pushed the clot toward the right main bronchus to secure ventilation via the left lung. After many attempts to remove the massive clot, including suction and grasping with basket forceps, it was successfully dislodged by replacing the endotracheal tube with a new one while maintaining oxygenation by one-lung ventilation. Any small fragments of the clot that still remained were then removed by suction under fiberoptic bronchoscopy.ConclusionsHere, we report a case of endotracheal tube obstruction due to a clot derived from very late (6 days) bleeding after insertion of an MT tube. The patient was successfully rescued by replacing the clot-bearing endotracheal tube with a new one. This experience suggests that the intensive care physician should be aware of the potential risk of clot retention in endotracheal tubes after the elapse of several days.

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Acute airway obstruction as a result of minitracheotomy

Abstract: SummaryWe describe two cases of airway obstruction due to bleeding following minitracheotomy and discuss the indications for minitracheotomy and management of this complication.

Cited by 11 publications

References 12 publications

Successful Treatment of Pulmonary Lymphangioleiomyomatosis With Progestins

Successful Treatment of Pulmonary Lymphangioleiomyomatosis With Progestins

An unusual complication of minitracheostomy

Lower airway obstruction due to a massive clot resulting from late bleeding following mini-tracheostomy tube insertion and subsequent clot removal and re-intubation

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