Advertisement

Canadian Journal of Anesthesia

, 52:1099 | Cite as

Unilateral subcutaneous emphysema after percutaneous tracheostomy

  • Jee Jian
  • David T. Wong
Cardiothoracic anesthesia, respiration and airway
  • 464 Downloads

Abstract

Purpose

Percutaneous tracheostomy techniques are widely used in intensive care units. Subcutaneous emphysema is a rare but well recognized complication associated with this procedure. We report an unusual presentation ofsc emphysema after percutaneous tracheostomy. The clinical features, diagnosis and postulated mechanism are discussed.

Clinical features

A 39-yr-old man had percutaneous tracheostomy done after prolonged intubation in the intensive care unit. Subcutaneous emphysema developed over the right neck three days after the procedure. Associated skin erythema and fever mimicking deepsc infection resulted in neck exploration. No obvious lesion was found in the tracheobronchial tree.

Conclusion

Subcutaneous emphysema occurring after percutaneous tracheostomy could occur without significant injury to the tracheobronchial tree. We postulate that air leaking from the tracheostomy site might have been prevented by the snug fit between the tracheostomy tube and the skin, resulting in accumulation in the neck. Asymmetric dilatation of the trachea may explain the unilateral localization of the sc emphysema.

Objectif

Les techniques de trachéotomie percutanée sont largement utilisées dans les unités de soins intensifs (USI). Ľemphysème sous-cutané est une complication rare, mais bien connue, associée à cette intervention. Nous présentons un cas inhabituel ďemphysème sc suivant une trachéotomie percutanée.

Áléments cliniques

Une trachéotomie percutanée a été pratiquée chez un homme de 39 ans à la suite ďune intubation prolongée à ľUSI. Un emphysème sous-cutané s’est développé au câté droit du cou trois jours après ľintervention. Un érythème associé et une fièvre rappelant une infection sc profonde ont incité à une exploration du cou. Il n’y avait aucune évidence de lésion dans ľarbre trachéobronchique.

Conclusion

Ľemphysème sous-cutané observé après une trachéotomie percutanée peut survenir sans lésion significative de ľarbre trachéobronchique. Nous croyons que ľinfiltration gazeuse, provoquant ľaccumulation ďair dans le cou, aurait pu être évitée par un bon ajustement entre le tube de trachéotomie et la peau. La dilatation asymétrique de la trachée peut expliquer la localisation unilatérale de ľemphysème sc.

Keywords

Necrotizing Fasciitis Subcutaneous Emphysema Tracheostomy Tube Acoustic Neuroma Percutaneous Dilatational Tracheostomy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Emphysème sous-cutané unilatéral après une trachéotomie percutanée

References

  1. 1.
    Cooper RM. Use and safety of percutaneous tracheostomy in intensive care. Report of a postal survey of ICU practice. Anaesthesia 1998; 53: 1209–12.PubMedCrossRefGoogle Scholar
  2. 2.
    Fischler L, Erhart S, Kleger GR, Frutiger A. Prevalence of tracheostomy in ICU patients. A nation-wide survey in Switzerland. Intensive Care Med 2000; 26: 1428- 33.PubMedCrossRefGoogle Scholar
  3. 3.
    Beiderlinden M, Walz KM, Sander A, Groeben H, Peters J. Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve. Intensive Care Med 2002; 28: 59–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Freeman BD, Isabella K, Lin N, Buchman TG. A meta- analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest 2000; 118: 1412–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Polderman KH, Spijkstra JJ, de Bree R, et al. Percutaneous dilatational tracheostomy in the ICU. Optimal organization, low complication rates, and description of a new complication. Chest 2003; 123: 1595–602.Google Scholar
  6. 6.
    Kearney PA, Griffen MM, Ochoa JB, Boulanger BR, Tseui BJ, Mentzer RM jrJr. A single-center 8-year experience with percutaneous dilational tracheostomy. Ann Surg 2000; 231: 701–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Ciaglia P. Video-assisted endoscopy, not just endosco- py, for percutaneous dilatational tracheostomy. Chest 1999; 115: 915–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Hinerman R, Alvarez F, Keller CA. Outcome of bedside percutaneous tracheostomy with bronchoscopic guidance. Intensive Care Med 2000; 26: 1850–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Byhahn C, Lischke V, Meininger D, Halbig S, Westphal K. Peri-operative complications during percutaneous tracheostomy in obese patients. Anaesthesia 2005; 60: 12–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Fikkers BG, van Veen JA, Kooloos JG, et al. Emphysema and pneumothorax after percutaneous tracheostomy. Case reports and an anatomic study. Chest 2004; 125: 1805–14.PubMedCrossRefGoogle Scholar
  11. 11.
    Escarment J, Suppini A, Sallaberry M, et al. Percutaneous tracheostomy by forceps dilation: report of 162 cases. Anaesthesia 2000; 55: 125–30.PubMedCrossRefGoogle Scholar
  12. 12.
    Mostert MJ, Stuart H. Subcutaneous emphysema caused by a fenestrated tracheostomy tube. Anaesthesia 2001; 56: 191–2.PubMedCrossRefGoogle Scholar
  13. 13.
    Douglas WE, Flabouris A. Surgical emphysema following percutaneous tracheostomy. Anaesth Intensive Care 1999; 27: 69–72.PubMedGoogle Scholar
  14. 14.
    Kaylie DM, Wax MK. Massive subcutaneous emphysema following percutaneous tracheostomy. Am J Otolaryngol 2002; 23: 300–2.PubMedCrossRefGoogle Scholar
  15. 15.
    Wong DT, McGuire GP. Subcutaneous emphysema following trans-cricothyroid membrane injection of local anesthetic. Can J Anesth 2000; 47: 165–8.PubMedCrossRefGoogle Scholar
  16. 16.
    O’Rourke J, Fahy C, Donnelly M. Subcutaneous emphysema at the site of central line placement due to the haematogenous spread of Clostridium septicum (Letter). Eur J Anaesthesiol 2003; 20: 162–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Durrani MA, Mansfield JF. Anesthetic implications of cervicofacial necrotizing fasciitis. J Clin Anesth 2003; 15: 378–81.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  1. 1.Department of AnesthesiologyToronto Western Hospital, University Health Network, University of TorontoTorontoCanada
  2. 2.Department of AnesthesiologyToronto Western HospitalTorontoCanada

Personalised recommendations