Delayed massive hemorrhage following tracheostomy.

Mathog, Robert H.; Kenan, Patrick D.; Hudson, W R

doi:10.1288/00005537-197101000-00009

Cited by 36 publications

(8 citation statements)

References 21 publications

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“…7 Many authors 1,3,12,19 recommend over-inflation of the tracheostomy cuff to tamponade the bleeding vessel as an emergency measure before exploring the site. We feel over-inflation not only buys time for an emergency exploration, it also prevents aspiration of blood and can avoid the 'can't ventilate' situation.…”

Section: Discussionmentioning

confidence: 99%

A rare case of fatal haemorrhage after tracheostomy

Praveen

Martin²

2007

Ann R Coll Surg Engl

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Tracheo-arterial fistula after tracheostomy causing massive haemorrhage is fortunately rare, but can be serious and often fatal. Brachiocephalic trunk is commonly at risk of erosion because of its close relation with the trachea. Factors responsible for fistula are pressure from tube rubbing on the trachea and adjacent vessel, infection, malignant neoplastic invasion of a vessel near the trachea and low tracheostomy. We present a rare case of massive arterial bleeding which happened on the second day and recurred on fifth day, because of slippage of the ligature from the thyroid artery, causing aspiration and death. A low tracheostomy below the third ring should be avoided. If there is bleeding, as a first-aid measure the cuff should be over inflated without removing the tracheostomy tube.

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Section: Discussionmentioning

confidence: 99%

A rare case of fatal haemorrhage after tracheostomy

Praveen

Martin²

2007

Ann R Coll Surg Engl

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“…Innominate artery erosion is a rare but often fatal com plication of tracheostomy occurring most commonly be tween the first and second postoperative week [1][2][3][4], Few patients survive even if the surgical repair is successful [3,5]. The high mortality rate emphasizes the importance of both the surgical repair procedure and management to prevent such a disastrous complication [5].…”

Section: Discussionmentioning

confidence: 99%

“…Innominate artery erosion is due to local ischemia of the anterior tracheal wall caused by pressure from the tra cheal tube [3,4,[6][7][8]. When tracheostomy is done proper ly at the level of the second or third tracheal cartilage, innominate artery erosion develops from excessive pres sure from the cuff or the tip of the tube, except in cases when the innominate artery is abnormally high.…”

Section: Discussionmentioning

confidence: 99%

“…Use of the AF tube requires extra care in addition to routine care required in the case of a conventional tube. One can check for displacement of the tracheal tube radiographically in the antero-posterior and the lateral projection [4,8]. This procedure is recommended to verify correct fitting of the AF tube.…”

Section: Discussionmentioning

confidence: 99%

“…Many complications of tracheostomy are well known, and delayed massive hemorrhage due to innominate ar tery erosion has been reported as one of them since the 1950s [1][2][3][4]. More recently, tracheal tubes have been improved, and we have a choice of tracheal tubes to be fitted to the individual for various purposes.…”

Section: Introductionmentioning

confidence: 99%

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Innominate Artery Erosion Complicating Use of Tracheal Tube with Adjustable Flange

Yokoyama

Kaga

Suzuki³

et al. 1995

ORL

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A tracheal tube having an adjustable flange (AF tube) can be adjusted in cases of abnormal depth from skin to trachea. In a 43-year-old man with squamous cell carcinoma of the floor of the mouth, an AF tube was inserted because of severe edema of pretracheal tissues. He developed innominate artery erosion on the 6th postoperative day caused by the malfitted AF tube and died of recurrent hemorrhage 5 days after a surgical repair of the wound. The AF tube should be utilized not routinely but only in individuals with abnormal anatomy of the neck or trachea. Use of the AF tube requires extra care in addition to routine care required in the case of a conventional tracheal tube. Its correct fit should be verified initially by radiography. Fiberoptic examination should be employed within days after tracheostomy for patients with an AF tube to determine whether the tracheal mucosa is intact.

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