Tracheal dilatation. A complication of tracheostomy

Long-term follow-up of Griggs percutaneous tracheostomy with spiral CT and questionnaire

OBJECTIVE

To assess late complications following percutaneous tracheostomy using the Griggs technique.

DESIGN

Observational cohort study

SETTING

General ICU of a 700-bed district general hospital in the United Kingdom.

PATIENTS

Twenty-five patients who underwent Griggs tracheostomy in the ICU and survived for at least 6 months after decannulation.

INTERVENTION

Patients were invited to attend for assessment by questionnaire and for spiral CT of the trachea.

RESULTS

Eight patients had moderate tracheal dilatation, two patients were permanently hoarse, nine patients had minor voice changes, no patient had tracheal stenosis, and no patient had a disfiguring scar.

CONCLUSION

Following Griggs percutaneous tracheostomy, 8 of 25 patients developed moderate tracheal dilatation, and none developed a tracheal stenosis. The cosmetic result after Griggs tracheostomy is good, but the number of patients with minor voice changes is high. A further investigation of long-term outcome following Griggs tracheostomy is necessary.

Mechanical ventilation of a patient with decreased lung compliance and tracheal dilatation

Tracheal injury resulting from tracheal intubation is common. Injuries vary in type and severity, from mucosal sloughing to tracheal stenosis and fistula formation. We report a patient with poor lung compliance and massive tracheal dilatation as a result of prolonged mechanical ventilation with high inflation pressure despite the use of a high-volume, low-pressure cuff. To reduce the tracheal dilatation but maintain adequate ventilation and continuous positive airway pressure, we substituted a longer double-cuff tracheotomy appliance and used an automatic intermittent cuff inflator. The problems related to the design of modern tracheal tube cuffs are discussed.

Tracheal dilatation followed by stenosis in Mounier-Kuhn syndrome. A case report

A patient with previously undiagnosed Mounier-Kuhn syndrome (tracheobronchomegaly) was admitted with a head injury after a fall. The trachea was intubated with an oral tracheal tube with high-volume low-pressure cuff. The intracuff pressure was within the normal safe range recommended by the manufacturer. However, the patient developed tracheal dilatation on the second day after intubation. The trachea was extubated on the 15th day, and it was noticed 48 hours later that the patient was developing a tracheal stenosis at the site of the previous dilatation. The stenosis was so severe that the patient underwent resection-anastomosis surgery of his stenotic tracheal segment 2 months after extubation. It may be preferable in patients with Mounier-Kuhn syndrome who require mechanical ventilation to intubate the trachea with an uncuffed tube and to pack the throat to decrease the chances of gas leak and inhalation.

Enlarging intratracheal tube cuff diameter: a quantitative roentgenographic study of its value in the early prediction of serious tracheal damage

A prospective study to radiographically document impending tracheal damage in patients on continuous mechanical ventilation was done in 135 intubated adult patients over an eighteen month period. The previously unrecognized enlarging cuff/trachea ratio over 150% was seen in 18 patients. Five of 9 patients who died with C/T ratio over 150% were autopsied; all had severe tracheal damage at the cuff site. Four of 5 patients who were decannulated/extubated developed tracheal stenosis at the cuff site, necessitating tracheal resection in 3 patients. Thus a C/T ratio over 150% is a reliable clinical indicator of tracheal damage. Some thoughts as to prevention of this iatrogenic disease are presented.

Tracheal dilatation

Three cases of tracheal dilatation following prolonged ventilation through a tracheostomy tube with a conventional cuff are reported. The routine care of tracheostomies in the ITU at Northampton General Hospital is described. Possible causes for the development of dilatation are suggested and the symptoms and signs discussed.

Tracheal tube cuffs and tracheal dilatation

Although tracheal tube cuffs are well known to injure the trachea, attempts to design safer cuff systems have been only partially successful. In 14 dogs, we compared three models of high residual volume, low pressure cuffs, which are considered to be among the safest. Two were air-filled cuffs -- a maintained pressure cuff and a balloon reservoir cuff -- and the third was foam-filled. Tracheal dilatation was considerably more severe with mechanical ventilation than with spontaneous breathing, but the foam cuff produced significantly less dilatation (P less than .005) than the air-filled cuffs.