Paratracheal placement of orotracheal tube: a complication when aborting percutaneous tracheotomy

Percutaneous dilatational tracheotomies (PT) are commonly performed in the ICU. The procedure carries the risk of complications, among them severe events as loss of airway or pneumothorax. In this case report we describe complications related to a PT procedure in the ICU. The procedure was performed with a single dilator kit, and by visual guidance of a bronchoscope. Because of difficulties with the insertion of the tracheal cannula, the procedure was aborted, and the endotracheal tube (ET) reinserted. After placement of the ET, subcutaneous emphysema emerged. Upon digital exploration in the tracheotomy incision the tube was found to exit from the trachea, the tube-tip being situated para-tracheally. The tube position was corrected using a finger in the incision, and the patient could again be ventilated. Poor visual conditions may occur during PT because of bleeding. Importantly, there is a risk for the ET to exit an incision in the trachea when reintubating during a PT procedure, or after decannulation. This can be prevented using digital occlusion of the tracheal opening.