Anesth Pain Med.  2020 Jan;15(1):124-128. 10.17085/apm.2020.15.1.124.

Life-threatening tension pneumothorax after unsuccessful tracheostomy tube exchange in a trauma patient - A case report -

• Kwon MA
• Cho C
• Park JH

• KMID: 2500466
• DOI: http://doi.org/10.17085/apm.2020.15.1.124

Abstract

Background
Tracheostomy tube exchange is a common and safe procedure. However, when the tracheocutaneous tract is not completely mature, cannula exchange or endotracheal tube insertion via the tracheostomy site can rarely induce life-threatening complications, including subcutaneous emphysema, loss of airway, tension pneumothorax, and pneumoperitoneum. Case: We report a case of life-threatening tension pneumothorax developed during tracheostomy tube exchange with a reinforced endotracheal tube for a planned facial surgery after recent tracheostomy in a trauma patient.
Conclusions
Understanding of the pathogenesis and the use of preventive strategies based on it are expected to provide safer and more effective anesthetic management to patients with tracheostomy.

Keyword

Pneumothorax; Subcutaneous emphysema; Tracheostomy

Figure

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  Fig. 1 Preoperative chest X-ray.

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  Fig. 2 Chest X-ray after failed tracheostomy tube exchange.

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  Fig. 3 Chest X-ray after closed thoracotomy.

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