[Chylous ascites complicating domiciliary ventilation by tracheostomy]

Area of Science:

• Medicine
• Pulmonology
• Critical Care

Background:

• Domiciliary ventilation by tracheostomy (TDV) remains indicated despite non-invasive methods.
• Mechanical and infective complications are primary concerns in TDV.
• Chylous ascites is a rare complication of TDV.

Observation:

• A 65-year-old male on long-term TDV developed chylous ascites during hospitalization.
• Classical causes of chylous ascites were ruled out.
• CT scans revealed tracheal dilatation and an over-inflated tracheostomy cuff compressing the thoracic duct.

Findings:

• Chylous ascites was directly linked to thoracic duct compression by the tracheostomy cuff.
• Reducing the tracheostomy cuff inflation pressure successfully resolved the chylous ascites.
• The condition did not recur after cuff pressure adjustment.

Implications:

• Proper management of tracheostomy tube cuff pressure is critical for patients on TDV.
• Regular radiological monitoring is advised to detect tracheal dilatation associated with tracheostomy cuffs.
• This case underscores the need for vigilance regarding mechanical complications of TDV, even with advanced ventilation techniques.