Tracheoarterial fistula in a patient with amyotrophic lateral sclerosis successfully managed by overinflation of the tracheostomy tube cuff alone: a case report

BACKGROUND

Tracheoarterial fistula is the most devastating complication after tracheostomy, and its mortality, without definitive treatment, approaches 100%. In general, the combination of bedside emergency management, that is, overinflation of the tracheostomy tube cuff, and definitive treatment such as surgical or endovascular intervention is necessary to prevent the poor outcome. Patients with neuromuscular diseases such as amyotrophic lateral sclerosis are susceptible to tracheoarterial fistula because of long-term mechanical ventilation and muscle weakness.

CASE PRESENTATION

We describe a case of tracheoarterial fistula in a Japanese 39-year-old patient with amyotrophic lateral sclerosis with long-term ventilator management. The patient was clinically diagnosed with a tracheoarterial fistula because of massive bleeding following sentinel hemorrhage. The massive hemorrhage was controlled by overinflation of the tracheostomy tube cuff alone, without definitive treatment.

CONCLUSIONS

This case suggests overinflation of the tracheostomy tube cuff alone plays an important role, semi-permanently, in the management of tracheoarterial fistula, especially in cases where surgical or endovascular intervention is not indicated. Clinicians taking care of patients with tracheostomy undergoing long-term mechanical ventilation should be aware that tracheoarterial fistula might occur following tracheostomy.

Electron energy-loss spectroscopy study of amorphization process of graphite bombarded with hydrogen ions and energetic electrons at low temperatures

Structural change of graphite bombarded with hydrogen ions as well as energetic electrons is investigated mainly by the EELS (electron energy-loss spectroscopy) technique, with a focus on the formation of diamond-like amorphous (DLA) phase at low temperatures. The chemical effects of hydrogen ions on the amorphization process are examined by comparing the results obtained by hydrogen-ion bombardment with those obtained by electron bombardment. The critical temperatures for the formation of DLA phase during hydrogen-ion and electron bombardments are determined. Finally, a model of the amorphization process of graphite during ion-bombardment is presented.

Predicting to 9-month performance of premature infants

This article identifies variables found to be predictive of sensorimotor and psychosocial performance in infants at 9 months adjusted age. The subjects were 102 infants with a birth weight of less than 1,500 g, who were participants in an early intervention project. Multiple regression analyses disclosed that poor 9-month performance was related to a lack of special Neonatal Intensive Care Unit (NICU) intervention, to minority group membership, to birth weight, and to performance on selected tests administered in the NICU. We present implications for the early prediction of handicapping conditions and for further research.