Korean J Neurotrauma.  2018 Oct;14(2):155-158. 10.13004/kjnt.2018.14.2.155.

Tracheal Infection Resulting from High Endotracheal Tube Cuff Pressure in an Unconscious Patient with Brain Trauma

• Lee JM
• Park IS
• Lee CH
• Lee KH
• Chun DH
• Kim JY
• Lee YS

• KMID: 2424331
• DOI: http://doi.org/10.13004/kjnt.2018.14.2.155

Abstract

Deep neck infections (DNIs) are mainly caused by dental caries, tonsillitis, and pharyngitis; however, DNIs can also occur after head and neck trauma. A 79-year-old male patient underwent a craniectomy due to an acute subdural hematoma. The patient was unconscious and continued to have a fever, but no clear cause was found. On postoperative day 9, he suddenly showed redness and swelling on the anterior neck. Enhanced computed tomography of the pharynx revealed tracheal necrosis and an abscess in the surrounding area. An incision and drainage were performed and Enterobacter aerogenes and E. faecalis were identified. The infection was controlled after antibiotic treatment. High endotracheal tube cuff pressure was suspected as the cause of the tracheal infection. Although DNIs are difficult to predict in patients who cannot report their symptoms due to unconsciousness, prevention and rapid diagnosis are important, as DNIs have serious side effects.

Keyword

Cuff pressure; Deep neck infection; Endotracheal intubation; Fever; Tracheal necrosis

MeSH Terms

Abscess
Aged
Brain Injuries*
Brain*
Dental Caries
Diagnosis
Drainage
Enterobacter aerogenes
Fever
Head
Hematoma, Subdural, Acute
Humans
Intubation, Intratracheal
Male
Neck
Necrosis
Palatine Tonsil
Pharyngitis
Pharynx
Tonsillitis
Unconsciousness

Figure

• 

  FIGURE 1 Preoperative and postoperative brain CT. (A) Preoperative brain CT scan shows increased right convexity subdural hematoma with midline shift to the left. (B) The CT scan from postoperative day 8 shows resolving hematoma and improved midline shifting.

• 

  FIGURE 2 Contrast-enhanced neck CT scan. An over distension state of the upper (cervical) trachea and adjacent soft tissue with air bubbles around the trachea, the right thyroid gland, and both visceral spaces are shown (A and B). Severe infection and necrosis around the endotracheal tube cuff is revealed (C and D, white arrow).

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