Management of post-intubation tracheal membrane ruptures: A practical approach

Tracheal Rupture After Tracheostomy Tube Exchange in a Patient With Recurrent Oral Cavity Spindle Cell Carcinoma

Oral Cavity Spindle Cell Carcinoma (OCSCC) is a rare variant of squamous cell carcinoma involving the nasopharynx and oral mucosa. This tumor has a high propensity to invade local structures of the head and neck region, making surgical removal challenging and potentially morbid for the patient. Here, we report a case of OCSCC and the complications that were confronted during its surgical resection. Additionally, a review of the literature regarding OCSCC complications and their treatments was performed.

Multidisciplinary management of tracheobronchial injury

Tracheobronchial injury is a heterogeneous entity comprising multiple rare and potentially life-threatening scenarios. We performed a systematic literature review focusing on post-intubation tracheal injuries (PiTIs) and post-traumatic tracheobronchial injuries (PTTBIs).PiTIs are often longitudinal lacerations of the middle third of the membranous trachea. Subcutaneous emphysema of the face and trunk following tracheal intubation should immediately trigger the diagnosis. Diagnosis may be suspected on the chest computed tomography (CT) and should be confirmed by bronchoscopic examination. Conservative management is encouraged for a spontaneously breathing or stable patient on noninvasive ventilation. Surgical repair is mandatory when mechanical ventilation is required and if bridging of the injury is impossible.PTTBIs are often associated with other severe injuries. Patients often present with massive subcutaneous emphysema and intractable pneumothorax. Diagnosis may be suspected on the chest CT and should be confirmed by bronchoscopic examination. Early surgical repair is indicated. In selected patients, conservative management can be considered.

Iatrogenic tracheal rupture after extubation in the context of acute decompensated heart failure and cardiac device implantation: a case report

Iatrogenic tracheal rupture is a life-threatening airway complication. It has a very low reported incidence and is more prevalent in women and patients over 50 years of age. The most frequent clinical manifestations of tracheal injury are subcutaneous emphysema and respiratory distress. We report a case of a 65-year-old woman with cardiac resynchronization therapy defibrillator implantation under general anesthesia. Shortly after extubation, dyspnea and subcutaneous emphysema appeared. The X-ray showed pneumomediastinum, pneumopericardium and pneumoperitoneum. The tracheal rupture was confirmed by bronchoscopy. After conservative treatment, the patient's well-being improved, and she was discharged from the hospital in a satisfactory condition.

Iatrogenic tracheal rupture after extubation in the context of acute decompensated heart failure and cardiac device implantation: a case report

Iatrogenic tracheal rupture is a life-threatening airway complication. It has a very low reported incidence and is more prevalent in women and patients over 50 years of age. The most frequent clinical manifestations of tracheal injury are subcutaneous emphysema and respiratory distress. We report a case of a 65-year-old woman with cardiac resynchronization therapy defibrillator implantation under general anesthesia. Shortly after extubation, dyspnea and subcutaneous emphysema appeared. The X-ray showed pneumomediastinum, pneumopericardium and pneumoperitoneum. The tracheal rupture was confirmed by bronchoscopy. After conservative treatment, the patient's well-being improved, and she was discharged from the hospital in a satisfactory condition.

Silicone Y-stent insertion under extracorporeal membrane oxygenation (ECMO) in a patient with tracheal tear

Tracheal tear after endotracheal intubation is extremely rare. The role of silicone Y-stent in the management of tracheal injury has been documented in the previous studies. However, none of the studies have mentioned the deployment of silicone Y-stent via rigid bronchoscope with the patient solely supported by extracorporeal membrane oxygenation (ECMO) without general anaesthesia delivered via the side port of the rigid bronchoscope. We report a patient who had a tracheal tear due to endotracheal tube migration following a routine video-assisted thoracoscopic surgery sympathectomy, which was successfully managed with silicone Y-stent insertion. Procedure was done while she was undergoing ECMO; hence, no ventilator connection to the side port of the rigid scope was required. This was our first experience in performing Y-stent insertion fully under ECMO, and the patient had a successful recovery.

STUDIES ON THE APPLICATION OF THE VIRTUAL BRONCHOSCOPY METHOD FOR TRACHEAL AND BRONCHIAL RUPTURES

Traumatic injuries of major airways (trachea and main bronchus) are rare in medical practice but represent extremely life-threatening conditions. The study aims to present a summary of research findings on the diagnostic capabilities of Virtual bronchoscopy (VB) in ruptures of trachea and bronchi. There is very little research into the applicability of VB in Bulgaria. Still, the modern equipment for MDCT VB during the last years provides to use the VB in diagnostic practice and for scientific examinations. The method of VB is recognized as a reliable tool in diagnostic practice and the research of tracheal and bronchial ruptures.

Effect of Cuff Pressures on Postoperative Sore Throat in Gynecologic Laparoscopic Surgery: An Observational Study

Context

Postoperative sore throat (POST) is a very common complaint following tracheal intubation. Although it resolves spontaneously, efforts must be taken to reduce it.

Aims

This study aims to compare the effect of cuff inflation using manometer versus conventional technique on the incidence of POST. Secondary objectives were to assess the incidence postoperative hoarseness and cough.

Settings and Design

A total of 120 patients were included in this prospective observational comparative study.

Subjects and Methods

After approval from the hospital ethics committee, consenting American Society of Anesthesiologists physical status Class I and II patients, scheduled for gynecologic laparoscopic surgery under general anesthesia, were included. They were randomly allocated by closed envelope technique to either Group A where the cuff pressure was adjusted to 25 cmH₂O using a manometer or Group B where cuff inflation was guided clinically. Patients were monitored for sore throat, hoarseness of voice, and cough postoperatively.

Statistical Analysis Used

To calculate the incidence of sore throat, hoarseness, and cough, descriptive statistics were applied. For checking association of sore throat and cuff pressure, Chi-square test and for comparing numerical values independent sample t-test were applied.

Results

The incidence of POST was significantly less in Group A than in B (P < 0.001) up to 24 h. Incidence of hoarseness was less in Group A and incidence of cough was higher in Group B, but these differences were not statistically significant.

Conclusion

Cuff inflation guided by manometer significantly reduces the incidence of POST.

Update on the diagnosis and treatment of tracheal and bronchial injury

Tracheal and bronchial injury, including iatrogenic injury and traumatic injury, the former usually occurred in the operation, intubation or bronchoscopy. The latter was occurred in a variety of blunt trauma, often combined with a variety of complex injuries. The therapeutic approach can be differentiated, surgical or conservative, no criteria has been universally accepted. Successful treatment of tracheobronchial injuries requires early diagnostic evaluation. This article aims to review the indications and therapeutic options for tracheal and bronchial injuries.

The Diagnosis and Management of Patient with Delayed Symptoms from a Tracheal Tear

Development of subcutaneous emphysema after gastrointestinal endoscopy with general anesthesia presents a diagnostic conundrum. We discuss the management of a patient who experienced significant vomiting followed by neck and facial swelling with crepitus and shortness of breath after the endoscopic retrograde cholangiopancreatography. The presence of respiratory distress usually suggests that head and neck subcutaneous emphysema is most likely associated with pneumothorax and/or pneumomediastinum. We discuss the prevention, differential diagnosis, and current management of tracheal tears including subcutaneous emphysema.

Ventilator strategies for VV ECMO management with concomitant tracheal injury and H1N1 influenza

Tracheal injury is a rare but highly morbid complication of endotracheal intubation. Recent reviews have advocated conservative management of these injuries without operative intervention. Extracorporeal membrane oxygenation may be a useful tool in non-operative management of tracheal injury in the setting of severe respiratory failure and need for prolonged intubation. We present a morbidly obese 33 year-old-female with H1N1 influenza pneumonia complicated by acute respiratory distress syndrome and bacterial super-infection who sustained a post-intubation tracheal injury. Concomitant tracheal injury and acute lung injury pose a difficult ventilation dilemma. This patient was successfully managed by venovenous extracorporeal membrane oxygenation, high frequency oscillator ventilation, proning position and tube thoracostomy. The venovenous extracorporeal membrane oxygenation and ventilator management were essential for this patient's recovery.