Pneumomediastinum and pneumoperitoneum caused by tracheostomy displacement

Kniese, Christopher; Jan, Muhammad Y; Diab, Khalil

doi:10.1136/bcr-2015-211238

Cited by 3 publications

(5 citation statements)

References 4 publications

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“…This case brings forth one of the rare combinations of complications of tracheostomy: subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum. There have been some case reports in the past on pneumomediastinum, pneumoperitoneum, and subcutaneous emphysema after tracheostomy [ 2 - 5 ]. The discussion of this case report focuses on the mechanism of pneumomediastinum due to tracheostomy and the development of pneumoperitoneum from pneumomediastinum.…”

Section: Discussionmentioning

confidence: 99%

“…Our patient had abdominal distention, but other features of pneumoperitoneum could not be determined since the patient was under sedation. Tension pneumoperitoneum can lead to tympany, tenderness, and abdominal compartment syndrome [ 5 ]. Operative intervention should not be undertaken in the absence of clinical and lab features of peritonitis.…”

Section: Discussionmentioning

confidence: 99%

“…Broadly, ectopic air after tracheostomy can be procedure-related (like the passage of air in the pretracheal fascia due to excessive dissection of tissue planes, tracheal wall injury/laceration), tracheostomy-tube related (blockage of the cannula, malpositioning, dislodgement, exchange of tracheostomy tubes) or alveolirelated (alveolar rupture from high ventilatory pressures, existing lung inflammation making it more susceptible to injury) [2][3][4][5][6][7]. The above-mentioned causes can lead to subcutaneous emphysema and pneumomediastinum with or without pneumothorax, which can track down to the peritoneum through hiatal openings in the diaphragm.…”

Section: Mechanism Of Pneumomediastinum After Tracheostomymentioning

confidence: 99%

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Air Will Find a Way: A Case Report and Literature Review on Tracheostomy-Induced Ectopic Air

Batth¹,

Singh²

2023

Cureus

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Tracheostomy can lead to various complications, one of which is ectopic air in different compartments of the body. Here, we present a rare case of tracheostomy-induced ectopic air: a combination of subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum. This case also presents a literature review on some of the common mechanisms responsible for pneumomediastinum following tracheostomy and the mechanism of pneumoperitoneum following pneumomediastinum. Tracheal injury, tube-related complications, and alveolar rupture are common mechanisms that can lead to pneumomediastinum and subcutaneous emphysema after tracheostomy. Air can then dissect into the abdomen leading to pneumoperitoneum. Knowledge of the anatomic or embryologic development of the thoracoabdominal continuum can help understand the spread of air from one compartment to another. Investigation as simple as a chest X-ray, along with clinical features, can help identify these complications and be used to monitor the course.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Mechanism Of Pneumomediastinum After Tracheostomymentioning

confidence: 99%

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Air Will Find a Way: A Case Report and Literature Review on Tracheostomy-Induced Ectopic Air

Batth¹,

Singh²

2023

Cureus

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“…Other conditions responsible for pneumomediastina are the performance of a vigorous Valsalva manoeuvre, rapid ascent of scuba-divers, presence of foreign bodies in the airway with air trapping, anorexia nervosa, sporting activities and inhalation of toxic fumes. 2 Several cases of iatrogenic pneumomediastinum due to dental, oral and maxillofacial surgery [3][4][5][6][7][8][9][10][11] or tracheotomy complication 13,14 have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Pneumomediastinum can very rarely complicate tracheotomy, with only two cases being reported and only one death described. 13,14 We focus on a case of an iatrogenic pneumomediastinum death after tracheotomy, focusing on the pathophysiology of death and the autopsy findings, compared to the only other recorded fatality.…”

Section: Introductionmentioning

confidence: 99%

Complication of tracheotomy: A case of fatal pneumomediastinum in spontaneous ventilation

et al. 2019

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Pneumomediastinum is defined as the presence of free air in the mediastinal space. It is classically defined as either spontaneous or secondary pneumomediastinum, depending on whether a cause can be recognised (e.g. trauma, intrathoracic infections or medical procedures such as dental or facial surgery and tracheotomy). It can be associated with pneumothorax and subcutaneous emphysema of the cervico-facial area because of the ascent of the air from the mediastinum towards the neck. To our knowledge, only one case of death from pneumomediastinum due to tracheotomy has previously been recorded. We report a case of death due to pneumomediastinum, which occurred in a patient with a tracheotomy during spontaneous ventilation. The 65-year-old man underwent surgical mandibular reconstruction with a custom-made titanium plate for osteonecrosis with temporary tracheotomy. The patient received mechanical ventilation only during surgery. On day 3, when the tracheotomy was closed, the patient experienced a rapid deterioration of lung ventilation with initial development of subcutaneous cervical emphysema. Although a tracheotomy tube was promptly inserted, the patient developed massive subcutaneous cervico-facial emphysema with a drop in oxygen capillary saturation. The man died after half an hour of resuscitation due to a massive pneumomediastinum. In this paper, we discuss the epidemiology, aetiology, physiopathology, complications and necropsy findings in pneumomediastinum, focusing on the aspects of our case compared to the only other case reported.

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Kidney disease in adults with Prader-Willi syndrome: international cohort study and systematic literature review

et al. 2023

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BackgroundPrader-Willi syndrome (PWS) is a rare, complex, genetic disorder characterized by hyperphagia, hypotonia, delayed psychomotor development, low muscle mass and hypothalamic dysfunction. Adults with PWS often have obesity, hypertension and type 2 diabetes mellitus (DM2), known risk factors for cardiovascular disease (CVD) and chronic kidney disease (CKD). Early symptoms of CVD and CKD may be masked by intellectual disability and inability to express physical complaints. Furthermore, kidney diseases are often asymptomatic. Therefore, renal and cardiovascular disease might be missed in patients with PWS. Microalbuminuria is an early sign of microvascular damage in the kidneys and other vascular beds. Therefore, we screened our adult PWS cohort for the presence of elevated urinary albumin and (micro)albuminuria.MethodsWe retrospectively collected anthropometric measurements, blood pressure, medical history, medication use, urine dipstick and biochemical measurements form electronic patient files. In addition, we performed a systematic literature review on kidney disease in PWS.ResultsWe included 162 adults with genetically confirmed PWS (56% male, median age 28 years), of whom 44 (27%) had DM2. None had known CVD. All subjects had normal estimated glomerular filtration rate (eGFR) according to non-PWS reference intervals. Elevated urinary albumin or (micro)albuminuria was present in 28 (18%); 19 out of 75 (25%) had an increased urinary albumin-to-creatinine ratio (UACR) and 10 out of 57 (18%) had an increased urinary protein-to-creatinine ratio. Elevated urinary albumin was present at a young age (median age 26 (IQR 24-32) years) and was associated with an significantly higher BMI and LDL-cholesterol levels and higher prevalence of DM2, hypertension and dyslipidemia than those with normal UACR (p=0.027, p=0.019, p<0.001, p<0.001, p=0.011 and respectively).ConclusionUpon screening, one in every five adults with PWS had increased urinary albumin or (micro)albuminuria, early signs of microvascular disease. All had normal eGFR, according to non-PWS reference intervals, and none had a formal diagnosis of CVD. As muscle mass is low in PWS, creatinine levels and eGFR may be spuriously normal. Urinalysis in this patient group can be used as a screening tool for microvascular (kidney) disease. We propose an algorithm for the detection and management of microvascular disease in adults with PWS.

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Pneumomediastinum and pneumoperitoneum caused by tracheostomy displacement

Cited by 3 publications

References 4 publications

Air Will Find a Way: A Case Report and Literature Review on Tracheostomy-Induced Ectopic Air

Air Will Find a Way: A Case Report and Literature Review on Tracheostomy-Induced Ectopic Air

Complication of tracheotomy: A case of fatal pneumomediastinum in spontaneous ventilation

Kidney disease in adults with Prader-Willi syndrome: international cohort study and systematic literature review

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