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Clinical Note |

Major Tracheal Tear and Bilateral Tension Pneumothorax Complicating Percutaneous Tracheostomy

Tomaz Stupnik, MD; Simona Steblaj, MD; Mihael Sok, PhD
Arch Otolaryngol Head Neck Surg. 2009;135(8):821-823. doi:10.1001/archoto.2009.88.
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Percutaneous tracheostomy is a frequently conducted procedure in critically ill patients. We report a case of a major tracheal tear (roughly four-fifths of the circumference) complicated by bilateral tension pneumothorax, a very rare but potentially life-threatening complication after percutaneous tracheostomy.

The most severely ill patients admitted to an intensive care unit (ICU) often require a tracheostomy. The standard surgical tracheostomy technique was described in 1909 by Jackson.1,2 In 1957, Shelden et al3 first described the percutaneous tracheostomy. In 1985, Ciaglia et al4 reported a method based on needle–guide wire airway access followed by serial dilatations with sequentially larger dilators (Ciaglia blue rhino). Griggs et al5 described the guide wire dilating forceps technique in 1990. In 2001, a PercuTwist percutaneous tracheostomy set was introduced by Rüsch, Kernen, Germany.6

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Major tracheal tear with endotracheal tube cuff effectively sealing the large air fistula.

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