Tracheomegaly Secondary to Tracheotomy Tube Cuff in Amyotrophic Lateral Sclerosis

Lee, Dong Hoon; Yoon, Tae Mi; Lee, Joon Kyoo; Lim, Sang Chul

doi:10.1097/md.0000000000001763

Cited by 5 publications

(11 citation statements)

References 5 publications

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“…In the acute setting, patients may have a persistent peritubal cuff leak on their endotracheal or tracheostomy tubes 14 , 15 , 16 , 17 and may require cuff overinflation to manage this cuff leak. 18 , 19 This peritubal cuff leakage may lead to difficulty maintaining the patient’s tidal volume and minute ventilation.…”

Section: Resultsmentioning

confidence: 99%

“… 17 Some patients may have had a history of a prior cuff rupture, likely secondary to gross hyperinflation. 15 , 18 When examined with tracheoscopy or bronchoscopy, there may be tracheal diverticulum 6 , 7 , 12 , 13 or dynamic collapse of the trachea on forced exhalation. 6 , 9 , 12 , 13…”

Section: Resultsmentioning

confidence: 99%

“…Risk factors for tracheomegaly include a history of obesity, 20 diabetes, 11 , 19 poor overall health, 11 smoking, 6 , 13 , 16 , 21 environmental exposures including heavy air pollution, 13 and prior lung transplantation. 14 In critically ill patients, this also includes prolonged mechanically assisted ventilation 2 , 6 , 11 , 15 , 21 and recurrent lung infections while intubated. 19 Other contributing factors are restlessness, 11 excessive endotracheal or tracheostomy tube movement, 19 poor nutrition, 11 muscle rigidity, 19 hypotension, 11 steroid therapy, 11 and the use of nasogastric tubes.…”

Section: Resultsmentioning

confidence: 99%

“…Tracheomegaly is associated with numerous chronic muscular, respiratory, or autoimmune illnesses including pulmonary fibrosis, 1 , 2 , 6 , 7 , 13 , 21 , 22 cystic fibrosis, 21 bronchiectasis, 7 , 13 , 14 emphysema, 7 , 16 chronic bronchitis, 7 , 16 amyotrophic lateral sclerosis (ALS), 15 sarcoidosis, 7 chronic progressive histoplasmosis, 1 and giant cell arteritis. 9 It has also been seen in a patient with tetany, 19 Ehlers-Danlos syndrome, Marfan syndrome, and cutis laxa.…”

Section: Resultsmentioning

confidence: 99%

“…A variety of surgical interventions have been suggested; however, these are multistaged surgical procedures that would carry significant risk and are not recommended during the acute phase of COVID-19. 15 Therefore, more conservative nonsurgical options are typical and appropriate. Chest physiotherapy and postural drainage can help with mobilizing secretions.…”

Section: Recommendationsmentioning

confidence: 99%

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Acquired Tracheomegaly in Critically Ill Patients With COVID-19: A Literature Review

Collins¹

2022

The Journal for Nurse Practitioners

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

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Acquired Tracheomegaly in Critically Ill Patients With COVID-19: A Literature Review

Collins¹

2022

The Journal for Nurse Practitioners

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Management of tracheostomy‐related tracheomegaly in a patient with COVID‐19 pneumonitis

Robinson

Manning

Jones

et al. 2020

Anaesthesia Reports

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Acquired tracheomegaly is a rare condition associated with pulmonary fibrosis, connective tissue disease and the use of cuffed tracheal tubes. We describe the urgent tracheal re-intubation and subsequent tracheal repair of a previously well 58-year-old man who developed tracheostomy-related tracheomegaly during prolonged mechanical ventilation for coronavirus disease 2019 pneumonitis. Urgent tracheal re-intubation was required due to a persistent cuff leak, pneumomediastinum and malposition of the tracheostomy tube. We describe the additional challenges and risks associated with airway management in patients with tracheomegaly, and discuss how even in urgent cases these can be mitigated through planning and teamwork. We present a stepwise approach to tracheal re-intubation past a large tracheal dilatation, including the use of an Aintree catheter inserted via the existing tracheal stoma for oxygenation or tracheal re-intubation if required. Computed tomography imaging was valuable in characterising the defect and developing a safe airway management strategy before starting the procedure. This report emphasises the role of planning, teamwork and the development of an appropriate airway strategy in the safe management of complex cases.

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Factors involved in the one‐year changes in the tracheal diameter of patients with amyotrophic lateral sclerosis undergoing tracheostomy positive pressure ventilation

Shibasaki,

Konishi,

Miyagawa

et al. 2023

Neurology & Clinical Neurosc

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BackgroundTracheostomy positive pressure ventilation (TPPV) is associated with complications in patients with amyotrophic lateral sclerosis (ALS), particularly tracheostomy tube‐related problems.AimTo determine the frequency of patients with ALS who received TPPV that have tracheal enlargement and factors associated with changes in tracheal diameter.MethodsWe included 43 patients with ALS undergoing TPPV who were admitted at Sayama Neurological Hospital in October 2019. The tracheal diameter at the height of the tracheostomy tube cuff was measured radiographically at specific time points. Tidal volume, inspiratory maximum pressure (PIP), dynamic lung compliance (Cdyn), tracheostomy tube cuff data, and patient demographic information and data were also collected.ResultsThe frequency of tracheomegaly was 60.5% at the initial data collection. The differences in tracheal diameter between the first measurement, after 12 months, and between 3 and 12 months were significant. ΔTracheal diameter correlated with TPPV duration, PIP, Cdyn, ΔPIP, ΔCdyn, and tracheal diameter. Multiple regression analysis, with Δtracheal diameter as the objective variable and TPPV duration, Cdyn, and tracheal diameter as explanatory variables, revealed an adjusted R‐square value of 0.36.ConclusionTracheomegaly and more enlarged tracheal diameters over time were more frequently observed in patients with ALS receiving TPPV. Furthermore, the trachea dilates over time and the tracheal diameter was related to baseline TPPV time, Cdyn, and tracheal diameter. Patients with shorter baseline TPPV duration, higher baseline Cdyn, and smaller baseline tracheal diameter were more likely to have larger tracheal diameters. Therefore, early prevention is important.

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Tracheomegaly Secondary to Tracheotomy Tube Cuff in Amyotrophic Lateral Sclerosis

Cited by 5 publications

References 5 publications

Acquired Tracheomegaly in Critically Ill Patients With COVID-19: A Literature Review

Acquired Tracheomegaly in Critically Ill Patients With COVID-19: A Literature Review

Management of tracheostomy‐related tracheomegaly in a patient with COVID‐19 pneumonitis

Factors involved in the one‐year changes in the tracheal diameter of patients with amyotrophic lateral sclerosis undergoing tracheostomy positive pressure ventilation

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