Dislodged Tracheostomy Tube
A 38 yo woman had been in ICU for 1 week following a traumatic brain injury, fractured ribs and ARDS. She was intubated and ventilated and had had a tracheostomy in place for 4 days. She was being nursed on a rotating bed.
Whilst being rotated the tracheostomy tube became dislodged and was re-inserted by the nursing staff.
The ventilator immediately alarmed and the patient was hand ventilated requiring high pressures.
The O2 saturation fell to 70% and systolic BP was noted to be 30.
A misplaced tracheostomy tube was suspected and the patient was intubated with an oral ETT without difficulty. High inspiratory pressures were still required. The O2 sat immediately recovered to 90%.
The BP was now 70/. Auscultation revealed poor air entry bilaterally and pneumothorax was suspected. A 14G cannula was inserted on the R side in the 2nd ICS in the MCLine resulting in an escape of gas and some improvement in vital signs.
A CXR showed bi-lateral pneumothorax. Intercostal catheters were inserted and the patient’s condition stabilised. She was kept intubated for 3 days, ARDS and TBI improved and she was extubated and made a full recovery.
Comment 1
Presumably the TT created a false passage when it was re-inserted, leading to surgical emphysema.
It is unclear how a tension pneumothorax occurred at this time.
Comment 2
Professor Vapour says should have checked it earlier