Tracheal rupture after tracheal intubation

Abstract

We report a case of tracheal rupture in an 84-yr-old patient after tracheal intubation. The aetiology and treatment are discussed and the recent literature is reviewed.

Bronchoscopic Diagnosis of an Extensive Tracheal Laceration

“…Endotracheal intubations complicated by tracheal lacerations, as in our case, are rare, as reflected by only 16 reported cases from 1966 to 1994 4 . It is postulated that the exertion of excessive cuff‐to‐tracheal wall pressure by endotracheal tubes causes ischaemic necrosis and consequently leads to subsequent injury.…”

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].…”

“…Direct trauma may result from the endotracheal tube, stylet or laryn- goscope. Although the injury may occur at any point in the larynx, sub-glottis or trachea, the most frequently reported site in adults is the membranous posterior portion of the trachea [3,5]. Multiple procedural and patient-related factors have been cited as potential risk factors of tracheal injury (Table 1) [2,6,7,10,17].…”

“…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.…”

Subcutaneous emphysema due to airway rupture after chronic endotracheal intubation

“…1,2 Putative factors to the rupture in these cases are: cuff over-distention, cuff permeability to nitrous oxide and increase in intrabronchial pressure. 3 Females are clearly more affected than males. 1,3 perhaps owing to a weakness of the membranous trachea.…”