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[Bilateral pneumothorax, cervicofacial and mediastinal emphysema after surgical tracheostomy].
Ann Fr Anesth Reanim. 2013 Oct; 32(10):718-20.AF

Abstract

Tracheotomy is a surgical procedure for various indications, such as ventilator dependence and airway obstruction. Reported rates in the literature of complications of tracheostomy vary widely. We report an unusual presentation of serious complication after surgical tracheostomy. The correct timing of tracheostomy is still controversial in the literature. A 74-year-old male had emergency surgical tracheostomy under general anesthesia. At the end of the procedure, in recovery room, he developed subcutaneous emphysema of the eyes. There was no pneumothorax seen on chest X-ray. Bronchoscopic examination through the tracheostomy tube showed no evidence of damage to the posterior tracheal wall. Three hours later patient had difficulty breathing requiring sedation with respiratory assistance. X-ray of the chest at this stage showed a right pneumothorax and extensive subcutaneous emphysema of the chest wall. Pneumothorax was managed using a chest tube. Two days after, a control CT scan of the chest showed a left pneumothorax and pneumomediastinum. The pneumothorax was managed using a chest tube. Bronchoscopic examination showed no obvious lesion in the tracheobronchial tree. The patient was treated successfully with supportive care and large doses of antibiotic to prevent mediastinitis. Seven days later, recovery was rapid and complete and CT scan of the chest was completely normal. The patient was discharged from the hospital on the 13th postoperative day. This case illustrates that complications occurring after surgical tracheostomy could be dramatic. Management of tracheotomy is important to prevent complications. There is still debate on optimal timing of tracheotomy. The last three trials have shown no interest to perform an early tracheotomy, neither in terms of vital prognosis nor in terms of the duration of mechanical ventilation.

Authors+Show Affiliations

Pôle d'anesthésie-réanimation, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens, France. Electronic address: badaoui.rachid@chu-amiens.fr.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

fre

PubMed ID

24035217

Citation

Badaoui, R, et al. "[Bilateral Pneumothorax, Cervicofacial and Mediastinal Emphysema After Surgical Tracheostomy]." Annales Francaises D'anesthesie Et De Reanimation, vol. 32, no. 10, 2013, pp. 718-20.
Badaoui R, Thiel V, Perret C, et al. [Bilateral pneumothorax, cervicofacial and mediastinal emphysema after surgical tracheostomy]. Ann Fr Anesth Reanim. 2013;32(10):718-20.
Badaoui, R., Thiel, V., Perret, C., Popov, I., & Dupont, H. (2013). [Bilateral pneumothorax, cervicofacial and mediastinal emphysema after surgical tracheostomy]. Annales Francaises D'anesthesie Et De Reanimation, 32(10), 718-20. https://doi.org/10.1016/j.annfar.2013.07.815
Badaoui R, et al. [Bilateral Pneumothorax, Cervicofacial and Mediastinal Emphysema After Surgical Tracheostomy]. Ann Fr Anesth Reanim. 2013;32(10):718-20. PubMed PMID: 24035217.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Bilateral pneumothorax, cervicofacial and mediastinal emphysema after surgical tracheostomy]. AU - Badaoui,R, AU - Thiel,V, AU - Perret,C, AU - Popov,I, AU - Dupont,H, Y1 - 2013/09/10/ PY - 2013/05/21/received PY - 2013/07/15/accepted PY - 2013/9/17/entrez PY - 2013/9/17/pubmed PY - 2014/6/19/medline KW - Emphysème sous-cutané KW - Pneumomediastinum KW - Pneumomédiastin KW - Pneumothorax KW - Subcutaneous emphysema KW - Surgical tracheostomy KW - Trachéotomie chirurgicale SP - 718 EP - 20 JF - Annales francaises d'anesthesie et de reanimation JO - Ann Fr Anesth Reanim VL - 32 IS - 10 N2 - Tracheotomy is a surgical procedure for various indications, such as ventilator dependence and airway obstruction. Reported rates in the literature of complications of tracheostomy vary widely. We report an unusual presentation of serious complication after surgical tracheostomy. The correct timing of tracheostomy is still controversial in the literature. A 74-year-old male had emergency surgical tracheostomy under general anesthesia. At the end of the procedure, in recovery room, he developed subcutaneous emphysema of the eyes. There was no pneumothorax seen on chest X-ray. Bronchoscopic examination through the tracheostomy tube showed no evidence of damage to the posterior tracheal wall. Three hours later patient had difficulty breathing requiring sedation with respiratory assistance. X-ray of the chest at this stage showed a right pneumothorax and extensive subcutaneous emphysema of the chest wall. Pneumothorax was managed using a chest tube. Two days after, a control CT scan of the chest showed a left pneumothorax and pneumomediastinum. The pneumothorax was managed using a chest tube. Bronchoscopic examination showed no obvious lesion in the tracheobronchial tree. The patient was treated successfully with supportive care and large doses of antibiotic to prevent mediastinitis. Seven days later, recovery was rapid and complete and CT scan of the chest was completely normal. The patient was discharged from the hospital on the 13th postoperative day. This case illustrates that complications occurring after surgical tracheostomy could be dramatic. Management of tracheotomy is important to prevent complications. There is still debate on optimal timing of tracheotomy. The last three trials have shown no interest to perform an early tracheotomy, neither in terms of vital prognosis nor in terms of the duration of mechanical ventilation. SN - 1769-6623 UR - https://www.unboundmedicine.com/medline/citation/24035217/[Bilateral_pneumothorax_cervicofacial_and_mediastinal_emphysema_after_surgical_tracheostomy]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0750-7658(13)01065-4 DB - PRIME DP - Unbound Medicine ER -