Negative pressure in upper airway obstructions, intermittent positive pressure ventilation (IPPV) after tracheotomy, direct pleural injury, tube displacement, or other etiology causing mediastinal air leakage are the causes of bilateral pneumothorax following tracheotomy (Cipriano et al. 2015; Kasugai et al. 2016; Jain et al. 2014). We thought direct pleural injury (related with procedure or cannula displacement), cannula displacement itself, or intermittent positive pressure ventilation were probable causes in our case.
In a case report, the authors detected hemi-lateral pneumothotrax, pneumomediastinum, and subcutaneous emphysema by chest X-ray and CT on the second day of emergency tracheotomy. They managed the patient successfully (Takasugi et al. 2018).
But in another case report, authors reported a fatal case of tension pneumothorax (a large right-sided pneumothorax) and subcutaneous emphysema after open surgical tracheostomy (Gupta and Modrykamien 2014).
In conclusion, here, we presented a successfully managed bilateral pneumothorax and subcutaneous emphysema after emergency open surgical tracheotomy. If there is a persistent reduction of SPO2 levels after tracheotomy, pneumothorax should be kept in the mind.