A rare early complication of tracheostomy

Area of Science:

• Critical Care Medicine
• Pulmonology
• Anesthesiology

Background:

• Polytrauma patients require intensive care, often necessitating mechanical ventilation and airway management.
• Tracheostomy is a common procedure in prolonged mechanical ventilation, but carries potential complications.
• Accurate diagnosis of respiratory distress is crucial for appropriate patient management.

Observation:

• A patient with polytrauma presented with respiratory issues post-tracheostomy weaning, initially misdiagnosed as asthma.
• Symptoms included expiratory stridor, dyspnea, and dysphonia, with transient response to asthma treatment.
• Deterioration led to an emergent re-intubation attempt, complicated by inability to pass an endotracheal tube.

Findings:

• Computed tomography (CT) scan confirmed tracheal stenosis as the underlying cause of respiratory compromise.
• The stenosis developed despite a relatively short duration (15 days) of the initial tracheostomy.
• An emergency tracheostomy was required to secure the airway due to the tracheal obstruction.

Implications:

• This case highlights the potential for rapid development of tracheal stenosis following tracheostomy, even in short durations.
• Clinicians should maintain a high index of suspicion for tracheal stenosis in ventilated patients with persistent or worsening respiratory symptoms.
• Prompt recognition and appropriate diagnostic imaging are essential to avoid delayed management and critical airway events.