Post-tracheostomy complications: respiratory failure caused by authologic foreign body-case report

Area of Science:

• Pulmonology
• Critical Care Medicine
• Otolaryngology

Background:

• Tracheostomy is a common palliative procedure for end-stage respiratory failure (RF).
• Prolonged mechanical ventilation post-tracheostomy can mask or lead to severe RF.
• Tracheal stenosis is a potential complication following tracheostomy.

Observation:

• Two cases of acute-on-chronic respiratory failure (ACRF) presented after tracheostomy (percutaneous dilatational tracheostomy and surgical tracheostomy).
• Patients experienced ACRF despite decannulation or failed weaning attempts.
• Stiff, calcified autologous cartilage fragments were identified as foreign bodies causing tracheal stenosis.

Findings:

• Noninvasive mechanical ventilation-assisted flexible bronchoscopy (NIV-FB) successfully diagnosed and treated tracheal stenosis in both patients.
• Histology confirmed tracheal cartilage calcification as the cause of autologous foreign body formation.
• NIV-FB proved safe and effective for managing tracheal stenosis in this context.

Implications:

• Ruptured tracheal cartilage ossification can cause life-threatening RF in patients with a history of tracheostomy.
• NIV-FB is a valuable tool for evaluating and treating suspected tracheal stenosis in respiratory failure patients.
• Early diagnosis and intervention with NIV-FB can prevent severe respiratory compromise.