Case Report of Multiple Tracheostomy Revisions due to Persistent, Recurrent Cuff Leak

This case is a patient with amyotrophic lateral sclerosis who was unable to be separated from mechanical ventilator support and required a tracheostomy. The patient underwent an initial open tracheostomy utilizing flexible fiberoptic tracheoscopy (FFT) in the operating room (OR). Subsequently, he de...

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Published in:	Case reports in anesthesiology Vol. 2015; no. 2015; pp. 1 - 3
Main Authors:	Azimi-Bolourian, Jian P., Williams, George W., Hanna, Issa A.
Format:	Journal Article
Language:	English
Published:	Cairo, Egypt Hindawi Publishing Corporation 01.01.2015 John Wiley & Sons, Inc Wiley
Subjects:	Anesthesiology Calcification Cardiovascular disease Case Report Catheters Colleges & universities Intensive care Maxillofacial surgery Neck Ostomy Ventilation Ventilators
ISSN:	2090-6382, 2090-6390
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Abstract	This case is a patient with amyotrophic lateral sclerosis who was unable to be separated from mechanical ventilator support and required a tracheostomy. The patient underwent an initial open tracheostomy utilizing flexible fiberoptic tracheoscopy (FFT) in the operating room (OR). Subsequently, he developed recurrent leaks in the tracheal tube cuff requiring multiple trips back to the operating room. The recurrent cuff leak occurred following each tube placement until the etiology of the leak was discovered during the fourth procedure. In the fourth procedure, the wound was explored more extensively, and it was found that there was a sharp, calcified, aberrant fragment of a tracheal cartilage ring protruding into the tracheal lumen, which was damaging the cuff of each tube. This fragment was not visible by multiple FFTs, nor was it visible in the wound by the surgeons until wider exploration of the wound occurred. The cartilage fragment was ultimately excised and the patient had no further cuff leaks. Aberrant tracheal cartilage should be on the differential diagnosis for cuff leaks subsequent to surgical tracheostomy (ST) or percutaneous dilatational tracheostomy (PDT).
AbstractList	This case is a patient with amyotrophic lateral sclerosis who was unable to be separated from mechanical ventilator support and required a tracheostomy. The patient underwent an initial open tracheostomy utilizing flexible fiberoptic tracheoscopy (FFT) in the operating room (OR). Subsequently, he developed recurrent leaks in the tracheal tube cuff requiring multiple trips back to the operating room. The recurrent cuff leak occurred following each tube placement until the etiology of the leak was discovered during the fourth procedure. In the fourth procedure, the wound was explored more extensively, and it was found that there was a sharp, calcified, aberrant fragment of a tracheal cartilage ring protruding into the tracheal lumen, which was damaging the cuff of each tube. This fragment was not visible by multiple FFTs, nor was it visible in the wound by the surgeons until wider exploration of the wound occurred. The cartilage fragment was ultimately excised and the patient had no further cuff leaks. Aberrant tracheal cartilage should be on the differential diagnosis for cuff leaks subsequent to surgical tracheostomy (ST) or percutaneous dilatational tracheostomy (PDT).
Author	Hanna, Issa A. Azimi-Bolourian, Jian P. Williams, George W.
AuthorAffiliation	1 Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, TX 77030, USA 2 Department of Oral Maxillofacial Surgery, The University of Texas School of Dentistry at Houston, Houston, TX 77030, USA 3 Departments of Anesthesiology and Neurosurgery, The University of Texas Medical School at Houston, Houston, TX 77030, USA
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/26240762$$D View this record in MEDLINE/PubMed
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Cites_doi	10.1053/ajot.2002.124192 10.1097/01.mlg.0000244181.01612.a6 10.1002/lary.22364 10.1007/s00405-014-3074-7 10.1016/j.joms.2011.09.022 10.1097/01.ccm.0000163401.77581.86 10.1097/01.mlg.0000251585.31778.c9 10.5001/omj.2011.12 10.1177/0885066613486739
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Copyright	Copyright © 2015 Jian P. Azimi-Bolourian et al. Copyright © 2015 Jian P. Azimi-Bolourian et al. Jian P. Azimi-Bolourian et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2015 Jian P. Azimi-Bolourian et al. 2015
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References_xml	– volume: 272 start-page: 1483 issue: 6 year: 2014 end-page: 1489 ident: 5 article-title: Is open tracheotomy performed by residents in otorhinolaryngology a safe procedure? a retrospective cohort study – volume: 33 start-page: 1015 issue: 5 year: 2005 end-page: 1020 ident: 7 article-title: Percutaneous translaryngeal versus surgical tracheostomy: a randomized trial with 1-yr double-blind follow-up – volume: 70 start-page: 890 issue: 4 year: 2012 end-page: 895 ident: 1 article-title: Retrospective study of tracheostomy indications and perioperative complications on oral and maxillofacial surgery service – volume: 117 start-page: 447 issue: 3 year: 2007 end-page: 454 ident: 8 article-title: Meta-analysis comparison of open versus percutaneous tracheostomy – volume: 23 start-page: 300 issue: 5 year: 2002 end-page: 302 ident: 10 article-title: Massive subcutaneous emphysema following percutaneous tracheostomy – volume: 122 start-page: 38 issue: 1 year: 2012 end-page: 45 ident: 2 article-title: A multi-institutional analysis of tracheotomy complications – volume: 29 start-page: 298 issue: 5 year: 2014 end-page: 301 ident: 3 article-title: Fatal case of tension pneumothorax and subcutaneous emphysema after open surgical tracheostomy – volume: 52 start-page: 427 issue: 5 year: 2009 end-page: 433 ident: 4 article-title: Tracheostomy: from insertion to decannulation – volume: 26 start-page: 48 issue: 1 year: 2011 end-page: 49 ident: 6 article-title: A rare early complication of tracheostomy – volume: 117 start-page: 176 issue: 1 year: 2007 end-page: 178 ident: 9 article-title: Aortic arch laceration: a lethal complication after percutaneous tracheostomy – ident: 10 doi: 10.1053/ajot.2002.124192 – ident: 9 doi: 10.1097/01.mlg.0000244181.01612.a6 – ident: 2 doi: 10.1002/lary.22364 – ident: 5 doi: 10.1007/s00405-014-3074-7 – ident: 1 doi: 10.1016/j.joms.2011.09.022 – ident: 7 doi: 10.1097/01.ccm.0000163401.77581.86 – ident: 8 doi: 10.1097/01.mlg.0000251585.31778.c9 – volume: 52 start-page: 427 issue: 5 year: 2009 ident: 4 publication-title: Canadian Journal of Surgery – ident: 6 doi: 10.5001/omj.2011.12 – ident: 3 doi: 10.1177/0885066613486739 – reference: 15891330 - Crit Care Med. 2005 May;33(5):1015-20 – reference: 19865580 - Can J Surg. 2009 Oct;52(5):427-33 – reference: 22043380 - Oman Med J. 2011 Jan;26(1):48-9 – reference: 12239698 - Am J Otolaryngol. 2002 Sep-Oct;23 (5):300-2 – reference: 23753246 - J Intensive Care Med. 2014 Sep-Oct;29(5):298-301 – reference: 22183627 - Laryngoscope. 2012 Jan;122(1):38-45 – reference: 17334304 - Laryngoscope. 2007 Mar;117(3):447-54 – reference: 17135981 - Laryngoscope. 2007 Jan;117(1):176-8 – reference: 24799085 - Eur Arch Otorhinolaryngol. 2015 Jun;272(6):1483-9 – reference: 22197004 - J Oral Maxillofac Surg. 2012 Apr;70(4):890-5
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SubjectTerms	Anesthesiology Calcification Cardiovascular disease Case Report Catheters Colleges & universities Intensive care Maxillofacial surgery Neck Ostomy Ventilation Ventilators
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Title	Case Report of Multiple Tracheostomy Revisions due to Persistent, Recurrent Cuff Leak
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