[A post-intubation tracheal rupture in intensive care unit]

Area of Science:

• Critical Care Medicine
• Anesthesiology
• Thoracic Surgery

Background:

• Tracheal rupture is a severe, underrecognized complication following endotracheal intubation.
• Risk factors include patient characteristics and procedural techniques.

Observation:

• An 86-year-old female with pancreatic cancer developed acute respiratory failure requiring mechanical ventilation.
• Intubation was performed emergently without a stylet, and the endotracheal tube cuff was inflated using a syringe.
• Immediate hemodynamic instability, gas exchange impairment, and subcutaneous emphysema were noted.

Findings:

• Computed tomography confirmed a supracarinal tracheal rupture.
• Patient factors contributing to tracheal wall fragility included female sex, age >50, and short stature.
• Procedural factors included emergency intubation and syringe-based cuff inflation.

Implications:

• Early diagnosis of tracheal rupture is crucial for patient prognosis.
• Standardized training on stylet use and cuff pressure monitoring are essential to prevent this complication.
• Increased vigilance is required for patients with predisposing factors.