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[Massive hemorrhage induced by tracheo-innominate artery fistula in two infants]
M Matsumoto1, Y Kawakami, H Naitoh
1Department of Anesthesia and Intensive Care, Hiroshima City Hospital.
Insights
Tracheo-innominate artery fistula can cause massive bleeding in children, often linked to prolonged tracheostomy tube use with inflated cuffs. Careful management of pediatric tracheostomized patients is crucial to prevent this rare but severe complication.
Area of Science:
- Medicine
- Pediatrics
- Surgery
Background:
- Tracheo-innominate artery fistula is a rare but life-threatening complication.
- It can lead to massive hemorrhagic shock, particularly in pediatric patients.
Observation:
- Two cases are presented: a 4-year-old girl with encephalitis on mechanical ventilation and a 6-year-old tracheostomized girl with congenital conditions.
- Both patients experienced massive hemorrhage due to tracheo-innominate artery fistula.
Findings:
- Prolonged tracheostomy tube use with an inflated cuff, especially in malnourished or immobilized pediatric patients, increases the risk.
- Concentrated cuff pressure on the tracheal wall is a key contributing factor.
Implications:
- While cuffed tubes are generally avoided in pediatrics, vigilant monitoring and specialized care are essential for tracheostomized children.
- Early recognition and management are critical for improving outcomes in this catastrophic complication.
Abstract:
Two cases of massive hemorrhagic shock induced by tracheo-innominate artery fistula are reported. The first case is a 4 year-old girl with encephalitis under prolonged mechanical ventilation. The second case is a 6 year-old tracheostomized girl with mental and motor retardation of congenital origin who has been taken care of at her home. This catastrophic complication is usually caused by long term placement of tracheostomy tube with the cuff inflated especially in malnourished pediatric patients. The cuff pressure is apt to be concentrated on one side of the tracheal wall especially in mechanically ventilated immobilized patients. Although this complication is rare because cuffed tube is currently avoided in pediatric patient, sophisticated care should be taken in managing tracheostomized patients.