Intraoperative herniation of a tracheostomy tube cuff

Abstract

A case of intraoperative tracheostomy tube obstruction is reported. The clinical features and the chain of events leading to the diagnosis of cuff herniation are presented. The different mechanisms of herniation are discussed. In the present case we speculate that a manufacturing defect together with nitrous oxide diffusion into the cuff caused dilatation and herniation of the latter which led to obstruction of the distal tube lumen. We draw attention to this rare but life-threatening complication.

Endotracheal tube obstruction due to cuff overinflation or cuff herniation in small equids: A case series

“…Secondly, in all cases, the cuff problem manifested as difficult ventilation, characterised by reduced gas flow and increased respiratory effort, or low delivered tidal volume despite high peak inspiratory pressures during IPPV. This agrees with previous observations reported in human (Barker & Stotz, 2013;Bar-Lavie et al, 1995;Davis et al, 2011;Hofstetter et al, 2010;Justiz & Mayhew, 2007;Kumar et al, 2021) and veterinary (Bergadano et al, 2004;Richardson & McMillan, 2017) literature on ETT obstruction. The sequelae can be severe, as severe hypercapnia and hypoxaemia can develop in minutes if critical hypoventilation is not promptly recognised and the problem resolved.…”

“…This may be either due to pressure‐induced luminal collapse of ETTs, or due to herniation of the cuff, which then obstructs the ETT outflow including the Murphy eye. There are several case reports in human medicine describing ETT obstruction due to cuff overinflation (Davis et al, 2011; Hofstetter et al, 2010; Zenga et al, 2018) and cuff herniation (Barker & Stotz, 2013; Bar‐Lavie et al, 1995; Kumar et al, 2021), but only two reports of cuff herniation in veterinary medicine (Bergadano et al, 2004; Richardson & McMillan, 2017). The possibility of ETT obstruction secondary to cuff overinflation may be an underrecognised phenomenon in equine practice, but it can be life‐threatening if not identified and resolved timely.…”

An in vitro study of tracheostomy tube cuff herniation and inflation characteristics

“…These problems may have a structural cause by way of a manufacturing defect or may be due to nitrous oxide diffusion into the cuff with resultant expansion and herniation (Stanley, 1975;Treffers and De Lange, 1989). Far fewer case reports have been made examining the problem existing with tracheostomy tubes (Bar-Lavie et al, 1995). This study was designed to examine the potential problem of tracheostomy tube cuff herniation in the tubes currently available in the UK.…”

“…Tracheostomy and endotracheal tube cuff herniation is an unusual cause of respiratory embarrassment which usually occurs in the per-operative period. Bar-Lavie et al (1995) reported a case of intraoperative cuff herniation involving a Shiley tracheostomy tube. Various other reports have been published of endotracheal tube cuff herniation involving other types of commercially available tubes (Robbie and Pearce, 1959;Ward et al, 1978;Davidson and Zimmer, 1989;Treffers and De Lange, 1989).…”

Change in Endotracheal Tube Cuff Pressure during Nitrous Oxide Anaesthesia: A Comparison between Air and Distilled Water Cuff Inflation

“…Sore throat and hoarseness 4,5 are the common postoperative symptoms. Rare but serious complications such as vocal cord paralysis 9 , cuff herniation causing occlusion 10 and vocal cord granuloma 11 have been reported after brief periods of intubation.…”