Potential risk of mass bleeding as a rare complication of tracheostomy
18 April 2018 (online)
Tracheostomies (TS) are one of the most frequent interventions in ENT or in intensive care. A distinction is made between open surgical TS and percutaneous, dilated TS. The most important indications are long-term ventilation, airway management in cases of tumorous, inflammatory or traumatic airway obstruction, respiratory protection or respiratory distress due to bilateral vocal cord arrest. The complications range from aspiration, wound healing disorders, emphysema, mediastinitis, insertion via falsa to rare massive bleeding. These bleedings are potentially life-threatening and are mainly due to injury or postoperative erosion of the brachiocephalic trunk (TB). The formation of a "tracheo innominate fistula" is a rare but usually fatal complication.
Based on a case report, the findings of and the procedure for a high-located TB compared to current literature will be described. The indication for open surgical TS in the 84-year-old woman was due to progressive dyspnoea with inspiratory stridor after Thyroidectomy with bilateral vocal cord arrest. Performing the open surgical TS the pulsating TB was recognized between 2nd and 3 rd tracheal clasp. Thereupon, the TS was put between the 1st and 2nd tracheal clasp and the TB was protected by a local myofascial flap.
Distal to the 4th tracheal clasp the high risk region of TB is located. Patients who underwent cervical or anterior mediastinal surgery or show difficult physique may require preoperative imaging and an open surgical TS should be chosen.