Intensive Care Unit Management of a Patient with Tracheal Rent Repair Following Laryngopharyngoesophagectomy

Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
Jenna AroraHimanshu Satpathy

Abstract

Tracheal injuries are one of the potentially fatal complications following laryngopharyngeal and esophageal surgeries. The patient developed tracheal rent during laryngopharyngoesophagectomy. The injury was diagnosed intraoperative and repaired. However, it did not heal, and the patient developed tracheopleural fistula. Right thoracotomy and latissimus dorsi flap was done under general anesthesia. Postsurgery, the patient was shifted to intensive care unit (ICU), where he developed respiratory distress not improving, with increasing oxygen flows. To avoid damage to the repair, under bronchoscopic guidance bilateral selective mainstem bronchial intubations were done using cuffed 5.0 mm regular endotracheal tubes (ETTs), and ventilation was supported on pressure control ventilation mode. The ventilator support was weaned off to pressure support ventilation mode on postoperative day (POD) 1. On POD2, ETTs were removed under bronchoscopic guidance and were replaced by 7 mm ID long and adjustable flange tracheostomy tube with the tip just above the carina. The cuff was kept deflated, and oxygen with the high flow was provided through a tracheostomy. The high flow was weaned off after 5 days. Later, the patient was managed conservati...Continue Reading

References

Aug 11, 2006·Chest·Massimo ContiCharles-Hugo Marquette
Jul 11, 2012·Anaesthesia·S FarrowN Soni
Jun 19, 2013·The Korean Journal of Thoracic and Cardiovascular Surgery·Jung Joo HwangTae Yeon Lee
Aug 8, 2013·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Dong YeCheng Kang
Jul 2, 2014·Journal of Cardiothoracic Surgery·Christos ProkakisDimitrios Dougenis
Jan 10, 2017·Journal of Thoracic Disease·Zehra HatipogluAlper Avci
Aug 23, 2017·Annals of Translational Medicine·Jean-Pierre FratArnaud W Thille

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