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VOLUME 24 , ISSUE 1 ( January, 2020 ) > List of Articles

CASE REPORT

Intensive Care Unit Management of a Patient with Tracheal Rent Repair Following Laryngopharyngoesophagectomy

Jenna Arora, Lalit Sehgal, Himanshu Satpathy

Keywords : Bilateral selective mainstem bronchial intubation, High-flow oxygen delivery devices, Laryngopharyngoesophagectomy, Tracheal rent, Tracheopleural fistula

Citation Information : Arora J, Sehgal L, Satpathy H. Intensive Care Unit Management of a Patient with Tracheal Rent Repair Following Laryngopharyngoesophagectomy. Indian J Crit Care Med 2020; 24 (1):77-79.

DOI: 10.5005/jp-journals-10071-23332

License: CC BY-NC 4.0

Published Online: 01-01-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Tracheal injuries are one of the potentially fatal complications following laryngopharyngeal and esophageal surgeries. The patient developed tracheal rent during laryngopharyngoesophagectomy. The injury was diagnosed intraoperative and repaired. However, it did not heal, and the patient developed tracheopleural fistula. Right thoracotomy and latissimus dorsi flap was done under general anesthesia. Postsurgery, the patient was shifted to intensive care unit (ICU), where he developed respiratory distress not improving, with increasing oxygen flows. To avoid damage to the repair, under bronchoscopic guidance bilateral selective mainstem bronchial intubations were done using cuffed 5.0 mm regular endotracheal tubes (ETTs), and ventilation was supported on pressure control ventilation mode. The ventilator support was weaned off to pressure support ventilation mode on postoperative day (POD) 1. On POD2, ETTs were removed under bronchoscopic guidance and were replaced by 7 mm ID long and adjustable flange tracheostomy tube with the tip just above the carina. The cuff was kept deflated, and oxygen with the high flow was provided through a tracheostomy. The high flow was weaned off after 5 days. Later, the patient was managed conservatively by regular chest physiotherapy, antibiotics, bronchoscopic pulmonary toileting, nebulizations, and appropriate antimicrobial therapy. Patient was discharged in stable condition from ICU and hospital.


  1. Prokakis C, Koletsis EN, Dedeilias P, Fligou F, Filos K, Dougenis D. Airway trauma: a review on epidemiology, mechanisms of injury, diagnosis and treatment. J Cardiothorac Surg 2014;9:117. DOI: 10.1186/1749-8090-9-117.
  2. Ye D, Shen Z, Zhang Y, Qiu S, Kang C. Clinical features and management of closed injury of the cervical trachea due to blunt trauma. Scand J Trauma Resusc Emerg Med 2013;21:60. DOI: 10.1186/1757-7241-21-60.
  3. Hwang JJ, Kim YJ, Cho HM, Lee TY. Traumatic tracheobronchial injury: delayed diagnosis and treatment outcome. Korean J Thorac Cardiovasc Surg 2013;46(3):197–201. DOI: 10.5090/kjtcs.2013.46.3.197.
  4. Machuzak MS, Santacruz JF, Jaber W, Gildea TR. Malignant tracheal-mediastinal-parenchymal-pleural fistula after chemoradiation plus bevacizumab: management with a Y-silicone stent inside a metallic covered stent. J Bronchology Interv Pulmonol 2015;22(1):85–89. DOI: 10.1097/LBR.0000000000000099.
  5. Farooqui AM, Mbarushimana S, Faheem M. Unusual case of acute tracheal injury complicated by application of positive end expiratory pressure (PEEP). BMJ Case Rep 2014;2014:bcr-2014-206882. DOI: 10.1136/bcr-2014-206882.
  6. Hatipoglu Z, Turktan M, Avci A. The anesthesia of trachea and bronchus surgery. J Thorac Dis 2016;8(11):3442–3451. DOI: 10.21037/jtd.2016.11.35.
  7. Wallet F, Schoeffler M, Duperret S, Robert MO, Workineh S, Viale JP. Management of low tracheal rupture in patients requiring mechanical ventilation for acute respiratory distress syndrome. Anesthesiology 2008;108(1):159–162. DOI: 10.1097/01.anes.0000296104.46682.ca.
  8. Farrow S, Farrow C, Soni N. Size matters: choosing the right tracheal tube. Anaesthesia 2012;67(8):815–819. DOI: 10.1111/j.1365-2044.2012.07250.x.
  9. Frat JP, Coudroy R, Marjanovic N, Thille AW. High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure. Ann Transl Med 2017;5(14):297. DOI: 10.21037/atm.2017.06.52.
  10. Corley A, Edwards M, Spooner AJ, Dunster KR, Anstey C, Fraser JF. High-flow oxygen via tracheostomy improves oxygenation in patients weaning from mechanical ventilation: a randomised crossover study. Intensive Care Med 2017;43(3):465–467. DOI: 10.1007/s00134-016-4634-7.
  11. Mitaka C, Odoh M, Satoh D, Hashiguchi T, Inada E. High-flow oxygen via tracheostomy facilitates weaning from prolonged mechanical ventilation in patients with restrictive pulmonary dysfunction: two case reports. J Med Case Rep 2018;12(1):292. DOI: 10.1186/s13256-018-1832-7.
  12. Conti M, Pougeoise M, Wurtz A, Porte H, Fourrier F, Ramon P, et al. Management of postintubation tracheobronchial ruptures. Chest 2006;130(2):412–418. DOI: 10.1378/chest.130.2.412.
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