Dilatational force in percutaneous tracheostomy : how much is too much?

A rare case of tracheoesophageal fistula and pneumothorax occurring simultaneously in a patient following percutaneous dilatational tracheostomy

“…reported 2 cases of tracheal rupture where authors suspected excessive force during tracheal dilatation caused the catastrophe. [ 6 ] Low placement of tracheostomy stoma may also have contributed to the creation of pneumothorax and TEF in our patient.…”