A 63-Year-Old Woman With Subcutaneous Emphysema Following Endotracheal Intubation*

Division of Pulmonary and Critical Care Medicine, Medical College of Georgia, 1120 15th Street, Room No. BBR5513, Augusta, GA 30912-3135, USA.
Chest (Impact Factor: 7.48). 08/2005; 128(1):434-8. DOI: 10.1378/chest.128.1.434
Source: PubMed
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    ABSTRACT: We present a case of a patient with severe chronic obstructive pulmonary disease who developed dramatic mediastinal and subcutaneous emphysema, without pneumothorax, following a difficult intubation. Misdiagnosis of tracheal rupture as barotrauma from alveolar overdistention initially delayed intervention and caused persistence of subcutaneous emphysema. Despite efforts to minimize tidal volume and airway pressure, the large airway disruption and positive-pressure ventilation resulted in tension subcutaneous emphysema with near-fatal hemodynamic compromise, oliguria, and respiratory acidosis. Decompression with subcutaneous vents immediately reversed the life-threatening circulatory and respiratory compromise and stabilized the patient until surgical correction of the tracheal tear could be accomplished.
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    ABSTRACT: Tracheal rupture after endotracheal intubation is a rare but serious complication. Its causes remain unclear but many physicians believe that weakness of the membranous trachea in patients with chronic illness is a leading factor. We present three patients who developed membranous tracheal rupture after emergent endotracheal intubation. Based on our experience and a review of the relevant literature, we emphasize selection of a correctly sized endotracheal tube to minimize the risk of rupture. Use of a smaller endotracheal tube in the emergent setting, especially for patients at potential risk of rupture due to steroid use or chronic illness, is highly recommended.
    No preview · Article · Sep 2008 · Tzu Chi Medical Journal
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