Shnaydman Ilya, Baum Jeffrey, Barda Liran, Modi Shrey, Kaufman Joyce, Rattan Rishi
Trauma and Critical Care, Department of Surgery, Westchester Medical Center, New York, USA.
Surgery, Mount Sinai South Nassau, Oceanside, USA.
Cureus. 2022 Jun 29;14(6):e26426. doi: 10.7759/cureus.26426. eCollection 2022 Jun.
Percutaneous dilational tracheostomy (PDT) is a commonly used technique in intensive care units (ICUs) for persistent respiratory failure. Early complications of placement includeairway loss, bleeding, and tracheal ring fracture. Tracheostomy tube fracture is a rarely reported complication that can lead to loss of airway and require emergent intervention. We present two case reports of tracheostomy flange fracture and dislocation after PDT. Shortly after insertion, the tracheostomy flange was incidentally noted to have irreparably fractured and separated from the outer cannula. Both patients were orotracheally intubated and converted to open revisional surgical tracheostomy. Outer cannula separation from the flange is a rare but important complication of PDT due to the risk of occult airway loss. The tracheostomy tube supplied in the PDT set is manufactured in three parts and the plastic outer cannula is snapped to the silicone flange during manufacturing. The flange is not meant to be separated during insertion or use. PDT insertion requires significant force to be exerted, as the catheter has to travel through the subcutaneous tissue of the neck before entering the trachea. These cases suggest that the junction of the flange and the outer cannula may be a weak point and that fracture and dislocation at that site may occur due to excessive or misdirected force. Dislocation may cause loss of airway and a need for orotracheal intubation as performed in our cases. Understanding this complication and carefully examining the flange after placement is essential for early recognition to avoid loss of airway.
经皮扩张气管切开术（PDT）是重症监护病房（ICU）中治疗持续性呼吸衰竭常用的技术。置管的早期并发症包括气道梗阻、出血和气管环骨折。气管切开套管骨折是一种鲜有报道的并发症，可导致气道梗阻，需要紧急干预。我们报告两例经皮扩张气管切开术后气管切开套管翼缘骨折和脱位的病例。置管后不久，偶然发现气管切开套管翼缘已发生无法修复的骨折并与外套管分离。两名患者均经口气管插管，并改行开放性改良手术气管切开术。由于存在隐匿性气道梗阻风险，外套管与翼缘分离是经皮扩张气管切开术一种罕见但重要的并发症。经皮扩张气管切开术套件中提供的气管切开套管由三部分制成，塑料外套管在制造过程中与硅胶翼缘扣合。翼缘在插入或使用过程中不应分离。经皮扩张气管切开术插入操作需要施加较大力量，因为导管在进入气管之前必须穿过颈部皮下组织。这些病例表明，翼缘与外套管的连接处可能是一个薄弱点，该部位可能因用力过大或方向错误而发生骨折和脱位。脱位可能导致气道梗阻，需要像我们病例中那样进行经口气管插管。了解这种并发症并在置管后仔细检查翼缘对于早期识别以避免气道梗阻至关重要。
