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Afiadigwe EE, Umeh US, Obasikene G, Chukwuanukwu TO, Ezeanolue BC. Fractured Metallic Tracheostomy Tube: A Rare Presentation of Bronchial Foreign Body. Niger J Clin Pract 2024; 27:678-681. [PMID: 38842719 DOI: 10.4103/njcp.njcp_541_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/11/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Tracheostomy is an important life-saving surgical procedure that could be used to secure the lower airway. It can however serve as a source of airway compromise when fragments from it are deposited. This condition must be diagnosed early enough, and appropriate intervention should be done to forestall potential morbidity and mortality. CASE REPORT A 56-year-old tracheostomized patient presented to the accident and emergency department with a 4-hour history of sudden onset choking cough and labored breathing. The shaft of his tracheostomy tube (TT) was fractured and subsequently aspirated while he was attempting to remove and clean the inner tube that morning. He has used the TT for about 6 years and lost to follow-up clinic visits. The chest radiograph showed the metallic foreign body lodged within the trachea. He had an emergency rigid bronchoscopy via the tracheostomy stoma, and the object was retrieved. All respiratory symptoms subsequently resolved, and a check radiograph showed normal findings. CONCLUSION Tracheostomy tube fracture and aspiration should be ruled out in every tracheostomized patient with sudden onset acute respiratory symptoms. Otolaryngologists must always emphasize the need for proper handling of TT, regular follow-up, and tube replacement when due.
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Affiliation(s)
- E E Afiadigwe
- Department of Otorhinolaryngology, CHS, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
| | - U S Umeh
- Department of Otorhinolaryngology, CHS, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
| | - G Obasikene
- Department of Otorhinolaryngology, CHS, Nnamdi Azikiwe University, Nnewi Campus, Nnewi, Anambra State, Nigeria
| | - T O Chukwuanukwu
- Department of Surgery, Nnamdi Azikiwe University, Nnewi, Nnewi, Anambra State, Nigeria
| | - B C Ezeanolue
- Department of ENT, University of Nigeria, Itukku-ozalla, Enugu, Enugu State, Nigeria
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Vakili Ojarood M, Samady Khanghah A. Successful removal of an aspirated broken metal tracheostomy tube from the right main bronchus: a case report. Ann Med Surg (Lond) 2023; 85:4547-4552. [PMID: 37663683 PMCID: PMC10473327 DOI: 10.1097/ms9.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/25/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction and importance Tracheostomy has been done since ancient Greece, but in today's modern format, it has been accepted for over one and a half centuries. Improvements in medical care and treatments have survived disabled patients who died in the past decades. Among these, tracheostomy tube (TT) segment aspiration was as rare as less than 100 cases have already been documented. We reported a case of aspirated metal TT to the right main bronchus from a 12-year-old teenage girl and then reviewed the available literature. Case presentation The patient suffered from subglottic stenosis affected after adenotonsillectomy remained for 6 years. She was referred to the emergency department for acute respiratory distress and cyanosis. Immediately underwent rigid bronchoscopy, and on the way to the operating room, she was oxygenated from the tracheal orifice. The detached part was successfully removed. Clinical discussion The common tracheostomy indications in children involve congenital or acquired airway stenosis, some conditions needing long-term ventilation, bilateral vocal fold insufficiency, and infectious compromise of the upper airway. Metal TTs for long-lasting are preferred to synthetic ones. Nevertheless, it has some potential complications. Conclusion Careful inspecting, especially metallic TTs, after every disinfection and regular follow-up by the surgeon, is highly recommended to prevent potential casualties.
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Affiliation(s)
| | - Ali Samady Khanghah
- Department of Surgery, Fatemi Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
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Mahattanasakul P, Kaewkongka T, Sriprasart T, Kerekhanjanarong V. Fracture Outer Metallic Tracheostomy Tube as an Airway Foreign Body. Indian J Otolaryngol Head Neck Surg 2022; 74:1752-1756. [PMID: 36452832 PMCID: PMC9702309 DOI: 10.1007/s12070-019-01744-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022] Open
Abstract
To study the clinical presentation, management and mechanism of fractured outer metallic tracheostomy tube presenting as tracheobronchial foreign body. A retrospective chart review patients with fracture outer metallic tracheostomy tube. Data regarding the patients' demographic data, diagnosis, clinical presentation, type of tracheostomy tube and site of fracture were analyzed. Total 4 cases of fracture outer metallic tracheostomy tube were found. There were 3 males and 1 female, average age 52.75 years, range 31-76 years. The common presentation were dyspnea, intolerable cough and decreased breath sound in 4(100%), 2(50%) and 2(50%) cases. The most serious presentation was cardiac arrested 1 case. The dislodged tube were retrieved by flexible and rigid bronchoscopy. The most common site of fracture were outer tube at mid shaft 3 cases (75%). All of this site had corrosion. Only 1 case (25%) was fracture at junction between neck plate and tube without corrosion. The average time of usage metallic tracheostomy tube was 24 days, range 3-34 days. Fracture tracheostomy tube is rare and serious medical emergency. The patients, caregivers and physicians should recognition and prompt action. Flexible or rigid bronchoscopy via tracheostoma can successfully removal the dislodge part. The mechanism of fracture may come from several factors. The defective manufacturer, stagnation of alkaline bronchial secretion, recurrence process of removal, cleaning and boiling of the tube can cause mechanical stress and degradation of passive film of the tubes. The patient education regarding the maintenance and regular checked up can possibly extinguish this complication.
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Affiliation(s)
- Patnarin Mahattanasakul
- Department of Otolaryngology, Head and Neck Surgery, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Tonphong Kaewkongka
- Department of Physics, Faculty of Sciences, Chulalongkorn University, Bangkok, 10330 Thailand
| | - Thitiwat Sriprasart
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Virachai Kerekhanjanarong
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330 Thailand
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Shnaydman I, Baum J, Barda L, Modi S, Kaufman J, Rattan R. Flange Fracture and Dislocation: An Unusual Complication of Percutaneous Tracheostomy. Cureus 2022; 14:e26426. [PMID: 35911337 PMCID: PMC9336827 DOI: 10.7759/cureus.26426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 12/03/2022] Open
Abstract
Percutaneous dilational tracheostomy (PDT) is a commonly used technique in intensive care units (ICUs) for persistent respiratory failure. Early complications of placement includeairway loss, bleeding, and tracheal ring fracture. Tracheostomy tube fracture is a rarely reported complication that can lead to loss of airway and require emergent intervention. We present two case reports of tracheostomy flange fracture and dislocation after PDT. Shortly after insertion, the tracheostomy flange was incidentally noted to have irreparably fractured and separated from the outer cannula. Both patients were orotracheally intubated and converted to open revisional surgical tracheostomy. Outer cannula separation from the flange is a rare but important complication of PDT due to the risk of occult airway loss. The tracheostomy tube supplied in the PDT set is manufactured in three parts and the plastic outer cannula is snapped to the silicone flange during manufacturing. The flange is not meant to be separated during insertion or use. PDT insertion requires significant force to be exerted, as the catheter has to travel through the subcutaneous tissue of the neck before entering the trachea. These cases suggest that the junction of the flange and the outer cannula may be a weak point and that fracture and dislocation at that site may occur due to excessive or misdirected force. Dislocation may cause loss of airway and a need for orotracheal intubation as performed in our cases. Understanding this complication and carefully examining the flange after placement is essential for early recognition to avoid loss of airway.
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Bd V, Kothari N. Use of Pilot Balloon to Fish Out Fractured Tracheostomy Tube: A Case Report. A A Pract 2020; 14:58-59. [PMID: 31789826 DOI: 10.1213/xaa.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Tracheostomy is a weaning technique in patients requiring prolonged ventilation. During this period, complications like tube blockage, fracture of the tracheostomy tube, or cuff rupture can occur. Fracture of the tracheostomy tube can result in the distal end of the tube being dislodged further down the trachea, leading to airway obstruction and hypoxia. We report fracture of a tracheostomy tube in which the distal end was removed, using the inflation line of the pilot balloon to pull out the broken end of the tracheostomy tube.
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Affiliation(s)
- Vaishnavi Bd
- From the Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, Jodhpur, India
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Hosur B, Ahuja CK, Virk RS, Singh P. Unusually dislodged tracheostomy tube with intact airway. BMJ Case Rep 2020; 13:13/7/e237195. [PMID: 32675135 DOI: 10.1136/bcr-2020-237195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Bharat Hosur
- Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Chirag Kamal Ahuja
- Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh Virk
- ENT, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Paramjeet Singh
- Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kumarasinghe D, Wong EH, Duvnjak M, Smith MC, Palme CE, Riffat F. Colonization rates of tracheostomy tubes associated with the frequency of tube changes. ANZ J Surg 2020; 90:2310-2314. [PMID: 32419324 DOI: 10.1111/ans.15970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Tracheostomy-tube change protocols are implemented primarily due to concern regarding infections. Currently changes vary from within 4 weeks post-insertion to 3 monthly thereafter. However, currently no evidence-based guidelines exist to justify these protocols. This study aims to assess the colonization of tracheostomy-tubes associated with the frequency of changes. METHODS A prospective cohort study over 18-months of adult tracheostomy patients at a single institution (inpatient/outpatients). Patients were grouped based on whether tubes were changed at ≤4 weeks or >4 weeks and microbiology swabs sent for microscopy, culture and sensitivities. RESULTS A total of 65 patients were enrolled. No statistically significant difference in colonization in patients undergoing tube changes more than every 4 weeks to those less than every 4 weeks was found (56.2% versus 57.1%, χ2 = 0.004, P = 0.95). CONCLUSION The timing of tracheostomy-tube changes may not affect colonization and infection rates. Routine changes for the purpose of reducing infection risk may not be needed unless clinically indicated.
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Affiliation(s)
- Dulitha Kumarasinghe
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Eugene H Wong
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Marin Duvnjak
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Mark C Smith
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
| | - Carsten E Palme
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Faruque Riffat
- Department of Otolaryngology-Head and Neck Surgery, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.,Department of Otolaryngology-Head and Neck Surgery, Macquarie University Hospital, Sydney, New South Wales, Australia
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Ambasta S, Gupta SL, Rajiv G, Swaminathan S. Fractured tracheostomy tube posted for bronchoscopic removal: An anesthetic challenge. Saudi J Anaesth 2018; 12:142-143. [PMID: 29416476 PMCID: PMC5789478 DOI: 10.4103/sja.sja_144_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - G Rajiv
- Department of Anaesthesiology, JIPMER, Puducherry, India
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Bacha S, Habibech S, Chabbou A. [Inhalation of unusual metallic foreign body]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:109-110. [PMID: 28259371 DOI: 10.1016/j.pneumo.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/11/2017] [Accepted: 01/21/2017] [Indexed: 06/06/2023]
Affiliation(s)
- S Bacha
- Faculté de médecine de Tunis, Abderrahmane Mami, Tunisie.
| | - S Habibech
- Faculté de médecine de Tunis, Abderrahmane Mami, Tunisie
| | - A Chabbou
- Faculté de médecine de Tunis, Abderrahmane Mami, Tunisie
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James Procter N, Louw C. A broken fenestrated tracheostomy tube fragment removed from the right main bronchus. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2016. [DOI: 10.1080/22201181.2016.1244315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gupta SL, Swaminathan S, Ramya R, Parida S. Fractured tracheostomy tube presenting as a foreign body in a paediatric patient. BMJ Case Rep 2016; 2016:bcr-2015-213963. [PMID: 26957033 DOI: 10.1136/bcr-2015-213963] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tracheostomy tube fracture and aspiration into the tracheobronchial tree leading to airway obstruction is a dangerous complication after tracheostomy. We report a case of a fractured tracheostomy tube in a 6-year-old child who had been maintained on a tracheostomy tube for the past 5 years. The tracheostomy tube got fractured at the junction of the tube and neck plate, and impacted in the trachea and right main bronchus. Rigid bronchoscopy performed through the tracheostomy stoma to retrieve the fractured tracheostomy tube and the anaesthetic management during the period are discussed.
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Affiliation(s)
| | - Srinivasan Swaminathan
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Pondicherry, India
| | - Ravivalar Ramya
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Pondicherry, India
| | - Satyen Parida
- Department of Anaesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Pondicherry, India
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Loh TL, Chin R, Flynn P, Jayachandra S. Fracture and aspiration of a tracheostomy tube. BMJ Case Rep 2014; 2014:bcr-2013-203232. [PMID: 24554685 DOI: 10.1136/bcr-2013-203232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 70-year-old woman presented with a fracture and aspiration of her polyvinyl chloride tracheostomy tube. Her chest X-ray showed that a foreign body was lodged in the right main bronchus. She was otherwise asymptomatic. The foreign body was removed under general anaesthesia using a flexible bronchoscope. The patient developed pneumonia after the procedure and was admitted to the intensive care unit. She was discharged home 5 days after the event with no permanent complications.
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Affiliation(s)
- Tze Ling Loh
- Nepean Hospital, Kingswood, New South Wales, Australia
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