Delayed complication of tracheocutaneous fistula closure with severe compromising subcutaneous emphysema

Lewis, Robert J.; Mandler, Ari; Pérez, Geovanny F.; Mudd, Pamela

doi:10.1136/bcr-2019-229526

Cited by 4 publications

(3 citation statements)

References 17 publications

(26 reference statements)

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“…[1][2][3] Hamman syndrome, a spontaneous event that has similar findings to those in our patient, includes pneumomediastinum, subcutaneous emphysema, and occasionally dysphonia that can occur in association with high intrathoracic pressures, such as Valsalva during labor. 4 One mechanism postulated by Parmaksizoglu et al 2 is the creation of a one-way valve phenomenon that encourages air to entrain along natural tissue planes, which is then unable to escape. In this case, large negative intrathoracic pressures generated by a heavily sedated patient with partial airway obstruction appear to have created such an effect.…”

Section: Discussionmentioning

confidence: 99%

Pneumothorax, pneumomediastinum, and dysphonia complicating awake transcarotid artery revascularization

Clark¹,

Curci²

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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A 59-year-old woman presented with advanced, symptomatic carotid artery stenosis in the setting of severe medical comorbidities including coronary artery disease, congestive heart failure with recent admission for exacerbation, and diabetes mellitus. She underwent awake transcarotid artery revascularization because of her medically high-risk status. Postoperatively, she was noted to have developed pneumothorax, pneumomediastinum, and dysphonia, thought to be secondary to entrained air during the course of low neck dissection for carotid artery exposure in the setting of partial airway obstruction and high negative intrathoracic pressures during the procedure. After conservative treatment, she ultimately enjoyed complete clinical resolution. This case demonstrates an unusual complication of awake transcarotid artery revascularization. (J Vasc Surg Cases and Innovative Techniques 2020;6:133-5.)

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Section: Discussionmentioning

confidence: 99%

Pneumothorax, pneumomediastinum, and dysphonia complicating awake transcarotid artery revascularization

Clark¹,

Curci²

2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…Notably, severe respiratory complications are also reported in the secondary intention technique, though at a lower frequency of 2% [35 ▪ ]. While most air leak complications happened in the hours after surgery, Lewis reports on a child developing subcutaneous emphysema causing respiratory compromise on postoperative day two [40].…”

Section: Tracheocutaneous Fistulamentioning

confidence: 99%

Pediatric tracheostomy decannulation: what's the evidence?

Raynor,

Bedwell

2023

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review Pediatric decannulation failure can be associated with large morbidity and mortality, yet there are no published evidence-based guidelines for pediatric tracheostomy decannulation. Tracheostomy is frequently performed in medically complex children in whom it can be difficult to predict when and how to safely decannulate. Recent findings Published studies regarding pediatric decannulation are limited to reviews and case series from single institutions, with varying populations, indications for tracheostomy, and institutional resources. This article will provide a review of published decannulation protocols over the past 10 years. Endoscopic airway evaluation is required to assess the patency of the airway and address any airway obstruction prior to decannulation. There is considerable variability in tracheostomy tube modification between published protocols, though the majority support a capping trial and downsizing of the tracheostomy tube to facilitate capping. Most protocols include overnight capping in a monitored setting prior to decannulation with observation ranging from 24 to 48 h after decannulation. There is debate regarding which patients should have capped polysomnography (PSG) prior to decannulation, as this exam is resource-intensive and may not be widely available. Persistent tracheocutaneous fistulae are common following decannulation. Excision of the fistula tract with healing by secondary intention has a lower reported operative time, overall complication rate, and postoperative length of stay. Summary Pediatric decannulation should occur in a stepwise process. The ideal decannulation protocol should be safe and expedient, without utilizing excessive healthcare resources. There may be variability in protocols based on patient population or institutional resources, but an explicitly described protocol within each institution is critical to consistent care and quality improvement over time. Further research is needed to identify selection criteria for who would most benefit from PSG prior to decannulation to guide allocation of this limited resource.

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“…The treatment begins with diagnostic laryngoscopy and bronchoscopy to determine whether the airway is adequate for TCF repair [ 19 ]. Some surgeons utilize excision of the fistulous tract with secondary intention healing to reduce the risk of postoperative subcutaneous emphysema, pneumomediastinum, and pneumothorax [ 20 ].…”

Section: Reviewmentioning

confidence: 99%

Tracheocutaneous Fistula After Tracheostomy: Spotlight on a Closure Technique With a High Success Rate

Aljehani,

Tamadhor,

Alkhunaizi

et al. 2023

Cureus

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Tracheostomy is a commonly performed procedure in patients requiring prolonged mechanical ventilation. While it effectively provides a secure airway, tracheostomy can lead to complications, such as tracheal stenosis, tracheomalacia granulation tissue, pneumonia, aspiration tracheovascular fistula, tracheoesophageal fistula, and tracheocutaneous fistula.In this systematic review, we aim to identify the most suitable closure method and compare recurrence outcomes between methods for persistent tracheocutaneous fistula (TCF) in all age groups. We conducted a bibliographic search between January 1st, 2011 and March 10th, 2021 in the PubMed, B-on, Scopus, and Web of Science databases, and also performed a manual search to identify relevant articles. Our inclusion criteria were case series or comparative studies of surgery for persistent TCF and the success rate of TCF closure in patients both below and above 18 years of age.After applying the inclusion criteria to the research results, we included nine studies in our analysis. We found that closure by secondary intention is the most effective method for TCF closure, followed by primary and secondary intention combined. The success rate with most of the techniques was high, regardless of the size of the fistula or associated comorbidities, and its simplicity makes it an appealing treatment option in the care of patients with TCF.In conclusion, this systematic review highlights the importance of selecting an appropriate closure method for persistent TCF and provides valuable insights into the success rate of various techniques.

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Delayed complication of tracheocutaneous fistula closure with severe compromising subcutaneous emphysema

Cited by 4 publications

References 17 publications

Pneumothorax, pneumomediastinum, and dysphonia complicating awake transcarotid artery revascularization

Pneumothorax, pneumomediastinum, and dysphonia complicating awake transcarotid artery revascularization

Pediatric tracheostomy decannulation: what's the evidence?

Tracheocutaneous Fistula After Tracheostomy: Spotlight on a Closure Technique With a High Success Rate

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