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Hosaka T, Furuno S, Terada M, Hamano Y, Komatsu K, Okubo K, Koyama Y, Suzuki T, Tsuji H, Tamaoka A, Mizutani T. Tracheoarterial fistula in a patient with amyotrophic lateral sclerosis successfully managed by overinflation of the tracheostomy tube cuff alone: a case report. J Med Case Rep 2023; 17:65. [PMID: 36829250 PMCID: PMC9960659 DOI: 10.1186/s13256-023-03799-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/31/2023] [Indexed: 02/26/2023] Open
Abstract
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.
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Affiliation(s)
- Takashi Hosaka
- Division of Clinical Medicine, Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan. .,Department of Internal Medicine, Ibaraki Western Medical Center, University of Tsukuba Hospital/Jichi Medical University Joint Ibaraki Western Regional Clinical Education Center, Chikusei, Ibaraki, 308-0813, Japan. .,Department of Internal Medicine, Ibaraki Western Medical Center, Chikusei, Ibaraki, 308-0813, Japan.
| | - Shintaro Furuno
- Department of Internal Medicine, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
| | - Makoto Terada
- grid.20515.330000 0001 2369 4728Division of Clinical Medicine, Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan ,grid.20515.330000 0001 2369 4728Department of Internal Medicine, Ibaraki Western Medical Center, University of Tsukuba Hospital/Jichi Medical University Joint Ibaraki Western Regional Clinical Education Center, Chikusei, Ibaraki 308-0813 Japan ,Department of Internal Medicine, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
| | - Yumiko Hamano
- Department of Otolaryngology, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
| | - Kenichi Komatsu
- Department of Internal Medicine, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
| | - Katsuichiro Okubo
- Department of Internal Medicine, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
| | - Yasuaki Koyama
- grid.412814.a0000 0004 0619 0044Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Ibaraki, 305-8576 Japan ,grid.414178.f0000 0004 1776 0989Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki 317-0077 Japan
| | - Tetsu Suzuki
- grid.20515.330000 0001 2369 4728Division of Clinical Medicine, Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan
| | - Hiroshi Tsuji
- grid.20515.330000 0001 2369 4728Division of Clinical Medicine, Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan
| | - Akira Tamaoka
- grid.20515.330000 0001 2369 4728Division of Clinical Medicine, Department of Neurology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8575 Japan
| | - Taro Mizutani
- Department of Anesthesiology, Ibaraki Western Medical Center, Chikusei, Ibaraki 308-0813 Japan
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