Munguía-Canales DA, Vargas-Mendoza GK, Izunza-Saldaña S, Lara-Calvillo AL

Language: Spanish
References: 15
Page: 527-529
PDF size: 431.59 Kb.

ABSTRACT

Background: among the complications of using the tracheal T-tube have been documented infections, obstruction due to mishandling of secretions and very rarely inhalation of the cannula or components.
Clinical case: female patient 46 years old, who attempted suicide 5 years ago that required mechanical ventilation and tracheostomy in intensive care after 14 days of stay, failed decannulation because of progressive dyspnea; tracheal stenosis was diagnosed and was treated with tracheal T-tube. Following loss of the outer security ring, during aspiration cannula suffered inhalation with subsequent respiratory distress. The patient comes to our department with tracheal stoma permeable but air flow decreased. A fiberoptic bronchoscopy (FOB) was performed and found decreased tracheal lumen at stoma level because drop of anterior wall in 20% of its light, hyperemic tracheal mucosa with slight edema, T-tube was lodged at the level of the carina, after removing it was found inside completely blocked by mucus. Patient responded favorably to withdrawal of the cannula and discharged to 2^nd day without complications.
Conclusion: inhalation of tracheal T-tube or any of its components requires immediate treatment; the management is to secure the airway, the withdrawal of inhaled body and the prevention or treatment of comorbidities.

REFERENCES

1. Zulueta JJ, Gerblich AA. Upper airway obstruction due to inhalation of a tracheal T-tube resulting in pulmonary edema. Chest 1992;102(2):644-645.

2. Shinkwin CA, Murty GE, Gibbin KP, Bradley PJ. Inhalation of a Montgomery Safe T-tube plug. J Laryngol Otol 1992;106(11):1004-1005.

3. Alpert CC, Brahen NH, Halstead LA, Baker JD 3rd. Aspiration into the trachea of a tracheal T-tube in a pediatric patient. Anesth Analg 1991;72(5):693-695.

4. Wahidi MM, Ernst A. The Montgomery T-tube tracheal stent. Clin Chest Med 2003;24(3):437-443.

5. Montgomery W. Reconstruction of the cervical trachea. 1964. Ann Otol Rhinol Laryngol 2004;113(1):1-15.

6. Montgomery WW. T-tube tracheal stent. Arch Otolaryngol 1965;82:320-321.

7. Montgomery WW, Montgomery SK. Manual for use of Montgomery laryngeal, tracheal, and esophageal prostheses: update 1990. Ann Otol Rhinol Laryngol 1990;150(Supp l):2-28.

8. Puma F, Ragusa M, Avenia N, Urbani M, Droghetti A, Daddi N, et al. The role of silicone stents in the treatment of cicatricial tracheal stenoses. J Thorac Cardiovasc Surg 2000;120(6):1064-1069.

9. Gaissert HA, Grillo HC, Mathisen DJ, Wain JC. Temporary and permanent restoration of airway continuity with the tracheal T-tube. J Thorac Cardiovasc Surg 1994;107(2):600-606.

10. Morales Gómez J, Téllez Becerra JL, González Calzadillas LF, Hernández Carrillo JA, Munguía Canales DA. Reforzamiento del tubo en T de Montgomery para tratamiento de la estenosis laringotraqueal compleja. Rev Inst Nal Enf Resp Mex 2007;20(3):222-226.

11. Guha A, Mostafa SM, Kendall JB. The Montgomery T-tube: anaesthetic problems and solutions. Br J Anaesth 2001;87(5):787-790.

12. Schumann S, Kirschbaum A, Schließmann SJ, Wagner G, Goebel U, Priebe HJ, et al. Low pulmonary artery flush perfusion pressure combined with high positive end-expiratory pressure reduces oedema formation in isolated porcine lungs. Physiol Meas 2010;31(2):261-272.

13. Udeshi A, Cantie SM, Pierre E. Postobstructive pulmonary edema. J Crit Care 2010;25(3):508.e1-508.e5.

14. Chuang YC, Wang CH, Lin YS. Negative pressure pulmonary edema: report of three cases and review of the literature. Eur Arch Otorhinolaryngol 2007;264(9):1113-1116.

15. Lynrah ZA, Goyal S, Goyal A, Lyngdoh NM, Shunyu NB, Baruah B, et al. Fractured tracheostomy tube as foreign body bronchus: Our experience with three cases. Int J Pediatr Otorhinolaryngol 2012;76(11):1691-1695.