[Arterio-tracheal fistula during long-term intubation of an awake patient. Case report (author's transl)].

Because of anterior softening of the trachea due to thyroid swelling a patient was intubated with a "Lanz-" endotracheal tube with low-pressure cuff after thyroidectomy. The awake, eating patient developed severe endotracheal haemorrhage during the 17 days of intubation. Thoracotomy revealed a 2 cm long horizontal rupture probably at the site of the tube tip at the anterior wall of the trachea. The opening was connected to a rupture of the right brachiocephalic trunk at its bifurcation. Interpositions of dacron prostheses between the trunk, the subclavian artery and the carotid artery and suture of the tracheal wall controlled the situation. However, the patient died from acute hepatic failure, as shown at post-mortem examination. This case report is a warning against long-term intubation of awake patients, as sometimes recommanded.