Abstract
Percutaneous dilatational tracheostomy (PDT) is a simple and rapid method of tracheostomy. However, a number of complications, such as subcutaneous emphysema, mediastinal emphysema, and pneumothorax, have been reported. We report a case of massive subcutaneous emphysema, mediastinal emphysema, and pneumothorax after PDT with the Blue Rhino method (BR), and discuss preventive measures against these complications. A 56-year-old woman with cerebral contusion, acute subdural hematoma, and lung contusion was weaned from ventilatory support but extubation with an orotracheal tube failed due to dyspnea. The following day, PDT with BR was performed, but the orotracheal tube was extubated prior to insertion of a tracheostomy tube. Massive subcutaneous emphysema, mediastinal emphysema, and right pneumothorax were confirmed immediately after PDT, suggesting that obstruction of the skin incision during insertion of the tracheostomy tube and proximal tracheal obstruction after extubation of the orotracheal tube during PDT with BR blocked evacuation of the high intratracheal pressure caused by coughing, and high-pressure air from the tracheostomy caused emphysema. PDT with BR may cause elevation of intratracheal pressure during insertion of the dilator and tube, and control of the pressure with airway management during PDT with BR is important for prevention of emphysema.
