Warner Matthew A, Fox Jonathan F
From the Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
A A Case Rep. 2016 Feb 15;6(4):77-9. doi: 10.1213/XAA.0000000000000235.
Tracheal wall disruption is a rare complication of endotracheal intubation, typically occurring in the posterior (membranous) trachea lacking cartilaginous support. We present the case of a 68-year-old man who developed an anterior tracheal tear after routine endotracheal intubation, most likely occurring secondary to protrusion of a factory-preloaded stylet beyond the distal orifice of the endotracheal tube. Tracheal disruption should be considered in any patient with subcutaneous emphysema and respiratory distress after tracheal extubation and confirmed with bronchoscopy. Conservative management may be appropriate for those with small tears, hemodynamic stability, and the ability to isolate the tear from positive pressure ventilation.
气管壁破裂是气管插管的一种罕见并发症，通常发生在缺乏软骨支撑的后（膜性）气管。我们报告一例68岁男性，在常规气管插管后发生了前气管撕裂，很可能是由于工厂预装的管芯突出到气管导管远端开口之外所致。对于任何气管拔管后出现皮下气肿和呼吸窘迫的患者，都应考虑气管破裂，并通过支气管镜检查确诊。对于裂口小、血流动力学稳定且能够将裂口与正压通气隔离开的患者，保守治疗可能是合适的。
