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J Thorac Cardiovasc Surg 2009;137:1562-1564
© 2009 The American Association for Thoracic Surgery

Brief Communication

A modified technique of selective lung ventilation through a tracheostomy to facilitate conservative management of iatrogenic tracheal rupture

^a Department of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom
^b Clinique de Chirurgie Thoracique, CHRU Lille, Lille, France

Received for publication January 16, 2008; accepted for publication March 2, 2008.

^_* Address for reprints: Simon Jordan, FRCS, Department of Thoracic Surgery, Royal Brompton Hospital, Sydney St, London SW3 6NP, United Kingdom. (Email: s.jordan@rbht.nhs.uk).

The first 20% of the full text of this article appears below.

We describe a modified technique of bilateral bronchial intubation through a tracheostomy to achieve conservative management of iatrogenic tracheal rupture.

Clinical Summary

A 77-year-old woman admitted to the intensive care unit after an out-of hospital respiratory arrest secondary to exacerbation of severe chronic obstructive pulmonary disease underwent a percutaneous dilatational tracheostomy (PCT) using the Ciaglia Blue Rhino (Cook UK Ltd, Letchworth, UK) dilator 5 days post-intubation. Immediately after the procedure, extensive subcutaneous thoracic emphysema and bilateral pneumothoraces developed in the patient. Computed tomography of the chest showed a distal tracheal tear with pneumomediastinum and pneumoperitoneum ( Figure 1). The patient was transferred to the Royal Brompton Hospital, for thoracic surgical management. Rigid bronchoscopy revealed a 5-cm longitudinal tear of the posterior wall of the trachea, extending proximally from the level of the carina ( Figure 2). Esophageal perforation was excluded by esophagoscopy.

View larger version (164K):   Figure 1. Computed tomography scan showing bilateral pneumothoraces and pneumomediastinum secondary to posterior tracheal tear.

View larger version (140K):   Figure 2. View at rigid bronchoscopy showing full-thickness tear of . . . [Full Text of this Article]