Management of massive air leak following intubation injury in a very low birth weight infant

Abstract

Perforation of an infant's trachea after orotracheal intubation for general anaesthesia is a rarely described serious complication. This article reports an unusual case of laceration of the trachea in an 8-week-old infant with a history of prolonged neonatal intubation needed to treat hyaline membrane disease. After diagnosis the tracheal injury was managed conservatively. Factors involved in the occurrence of the injury and its management are discussed.

Soft palate perforation during orotracheal intubation facilitated by the GlideScope videolaryngoscope

“…Perforations of the hypopharynx, esophagus, and larynx have been reported during attempted oral intubations performed during direct visualization with conventional laryngoscope blades [5][6][7][8][9].…”

Neonatal tracheal rupture complicating endotracheal intubation: a case report and indications for conservative management

“…The incidence of tracheal rupture following endotracheal intubation in the adult or pediatric population remains unknown with the majority of previous publications consisting of case reports. To date, we are aware of 32 cases in adults [2][3][4][5][6][7] and 10 cases in the pediatric population, of which 8 are neonatal [8][9][10][11][12][13][14][15]. One retrospective case series reported a 0.12% incidence of tracheal rupture following double-lumen intubation in patients undergoing lobectomy for lung cancer [4].…”

“…Tracheostomy or nasotracheal intubation, with the cuff inflated distal to the tear, are suggested as alternative measures for 1-2 cm lacerations. Successful conservative management of tracheal perforation in infants involves the placement of uncuffed tubes distal to the injury, holding of oral feeds and broad-spectrum antibiotic prophylaxis [1,13,15]. Feeding may be accomplished by means of a nasogastric tube placed under endoscopic or fluoroscopic guidance if esophageal injury has been ruled out.…”

“…The rapid occurrence of subcutaneous emphysema, with or without pneumomediastinum and pneumothorax, and the delayed occurrence of mediastinitis have been associated with high rates of morbidity and mortality [1]. This injury has been previously reported as a rare complication of endotracheal intubation in both adults [2][3][4][5][6][7] and children [8][9][10][11][12][13][14][15]. Although multiple anatomic and procedural risk factors have been noted [16,17], the true incidence of tracheal injury following intubation remains unknown.…”

Respiratory distress in a preterm baby

“…Early surgical repair has traditionally been the mainstay of treatment but successful conservative management has been described in cases with small tears and no air leakage 2 5. Previous case reports in the literature have demonstrated high morbidity and mortality (up to 75%) mandating prompt recognition, evaluation and management 2 5. Treatment is more likely to be successful if provided early before mediastinal compression causing cardiovascular compromise.…”