A rare case of fatal haemorrhage after tracheostomy

Abstract

Tracheo-arterial fistula after tracheostomy causing massive haemorrhage is fortunately rare, but can be serious and often fatal. Brachiocephalic trunk is commonly at risk of erosion because of its close relation with the trachea. Factors responsible for fistula are pressure from tube rubbing on the trachea and adjacent vessel, infection, malignant neoplastic invasion of a vessel near the trachea and low tracheostomy. We present a rare case of massive arterial bleeding which happened on the second day and recurred on fifth day, because of slippage of the ligature from the thyroid artery, causing aspiration and death. A low tracheostomy below the third ring should be avoided. If there is bleeding, as a first-aid measure the cuff should be over inflated without removing the tracheostomy tube.

Indications and immediate outcomes of tracheostomy in Rwanda

“…Immediate postoperative complications (within 24 hours) noted includes hemorrhage in 2 patients and subcutaneous emphysema in one patient. Bleeding can happen during and after the procedure and it can even be fatal when there is erosion of big vessels such as the brachiocephalic trunk, or slippage of a suture (24). Similar to our study, other studies report that when the procedure is performed in a tertiary hospital, it is generally safe (7).…”

“…Proponents for early tracheostomy for prolonged intubation argue that patients might develop complications from longstanding mechanical effects of the endotracheal tube such as laryngeal ulceration, erythema, granuloma formation or vocal cord paralysis to some extent and recommend early tracheostomy as it may reduce endotracheal tube associated complications and the stay in ICU (3,14,22,23 airway obstruction that required a tracheostomy among patients in 2 studies in Nigeria (5,6). Like any surgery, bleeding although rare, is a known complication in tracheostomy (24). In our study, no intra-operative complications were recorded among the 29 patients who underwent tracheostomy.…”

Hemorragia masiva por traqueostomía: caso clínico

“…El sangrado masivo por la traqueostomía, agudo o tardío, es una de las complicaciones que se dan por la comunicación anormal (fístula) entre la tráquea y la arteria innominada (figura 1) por procesos inflamatorios o mecánicos asociados a la punta de la cánula traqueal [9][10][11][12], y puede presentarse con la técnica abierta o percutánea [3,13]. Su incidencia es baja (0,1-1%), con un pico de presentación entre el día 7 y el 14, hasta la sexta semana [14][15][16].…”

“…Otros autores sugieren evitar el retiro de la cánula durante el episodio de sangrado masivo para evitar la broncoaspiración de sangre y la sobreinflación del manguito, a fin de comprimir los vasos mientras el paciente es llevado a cirugía [12]. No se recomienda retirar la traqueostomía ni intentar la intubación orotraqueal, puesto que aumenta el sangrado y la broncoaspiración de sangre [21].…”

“…No se recomienda retirar la traqueostomía ni intentar la intubación orotraqueal, puesto que aumenta el sangrado y la broncoaspiración de sangre [21]. Se sugieren tres maniobras en una situación de emergencia [12,21]:…”