Airway obstruction from tracheostomy balloon cuff herniation during oral cancer removal. Emergency successfully managed and lessons learnt from device malfunction
Copyright © 2020 Elsevier Ltd. All rights reserved..
OBJECTIVE: Tracheostomy tube cuff balloon herniation is a rare event and can determine airway obstruction. Sometimes the obstruction is not very evident but, if it is not correctly solved, can determine a severe hypoxia with patient's death.
MATERIAL AND METHODS: We present a 49-year-old male patient, with cT4aN0M0 squamous cell carcinoma of the oral cavity, who was admitted to the hospital for definitive surgical resection. Due to mass an endo-oral intubation was not possible, so a surgical tracheotomy was performed. General anaesthesia was induced with Propofol (2 mg/kg) and Fentanil (1 mcg/kg) without gas. Surgery commenced via a trans-oral and trans-cervical approach, but it was halted after approximately 2 min as oximetry demonstrated a progressive fall from 98% to 78%. After confirmation of correct function of anaesthetic devices, the endotracheal cannula was tested; although surgeon deflated the tube cuff, repositioned the tube, and re-inflated the cuff, oxygen saturation did not change. So, the cannula was changed and patient's saturation increased up to normal value.
RESULTS: The balloon cuff of the cannula showed a herniation, responsible of insufficient ventilation.
CONCLUSIONS: Cuff herniation should be considered in case of unexpected airway obstruction, and a systematic, rapid approach to investigation and management should ensure timely identification and correction.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:113 |
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| Enthalten in: |
Oral oncology - 113(2021) vom: 29. Feb., Seite 105048 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Pandolfini, Manlio [VerfasserIn] |
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| Links: |
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| Themen: |
Cannula defect |
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| Anmerkungen: |
Date Completed 15.11.2021 Date Revised 15.11.2021 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.oraloncology.2020.105048 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM317004638 |
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| 245 | 1 | 0 | |a Airway obstruction from tracheostomy balloon cuff herniation during oral cancer removal. Emergency successfully managed and lessons learnt from device malfunction |
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| 500 | |a Date Revised 15.11.2021 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2020 Elsevier Ltd. All rights reserved. | ||
| 520 | |a OBJECTIVE: Tracheostomy tube cuff balloon herniation is a rare event and can determine airway obstruction. Sometimes the obstruction is not very evident but, if it is not correctly solved, can determine a severe hypoxia with patient's death | ||
| 520 | |a MATERIAL AND METHODS: We present a 49-year-old male patient, with cT4aN0M0 squamous cell carcinoma of the oral cavity, who was admitted to the hospital for definitive surgical resection. Due to mass an endo-oral intubation was not possible, so a surgical tracheotomy was performed. General anaesthesia was induced with Propofol (2 mg/kg) and Fentanil (1 mcg/kg) without gas. Surgery commenced via a trans-oral and trans-cervical approach, but it was halted after approximately 2 min as oximetry demonstrated a progressive fall from 98% to 78%. After confirmation of correct function of anaesthetic devices, the endotracheal cannula was tested; although surgeon deflated the tube cuff, repositioned the tube, and re-inflated the cuff, oxygen saturation did not change. So, the cannula was changed and patient's saturation increased up to normal value | ||
| 520 | |a RESULTS: The balloon cuff of the cannula showed a herniation, responsible of insufficient ventilation | ||
| 520 | |a CONCLUSIONS: Cuff herniation should be considered in case of unexpected airway obstruction, and a systematic, rapid approach to investigation and management should ensure timely identification and correction | ||
| 650 | 4 | |a Case Reports | |
| 650 | 4 | |a Letter | |
| 650 | 4 | |a Cannula defect | |
| 650 | 4 | |a Endotracheal tube defect | |
| 650 | 4 | |a Head and neck cancer | |
| 650 | 4 | |a Management | |
| 650 | 4 | |a Oxygenation | |
| 700 | 1 | |a Di Stadio, Arianna |e verfasserin |4 aut | |
| 700 | 1 | |a Brenner, Michael J |e verfasserin |4 aut | |
| 700 | 1 | |a Pichi, Barbara |e verfasserin |4 aut | |
| 700 | 1 | |a Pellini, Raul |e verfasserin |4 aut | |
| 700 | 1 | |a McGrath, Brendan |e verfasserin |4 aut | |
| 700 | 1 | |a D'Ascanio, Luca |e verfasserin |4 aut | |
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