Fracture Outer Metallic Tracheostomy Tube as an Airway Foreign Body

To study the clinical presentation, management and mechanism of fractured outer metallic tracheostomy tube presenting as tracheobronchial foreign body. A retrospective chart review patients with fracture outer metallic tracheostomy tube. Data regarding the patients' demographic data, diagnosis, clinical presentation, type of tracheostomy tube and site of fracture were analyzed. Total 4 cases of fracture outer metallic tracheostomy tube were found. There were 3 males and 1 female, average age 52.75 years, range 31-76 years. The common presentation were dyspnea, intolerable cough and decreased breath sound in 4(100%), 2(50%) and 2(50%) cases. The most serious presentation was cardiac arrested 1 case. The dislodged tube were retrieved by flexible and rigid bronchoscopy. The most common site of fracture were outer tube at mid shaft 3 cases (75%). All of this site had corrosion. Only 1 case (25%) was fracture at junction between neck plate and tube without corrosion. The average time of usage metallic tracheostomy tube was 24 days, range 3-34 days. Fracture tracheostomy tube is rare and serious medical emergency. The patients, caregivers and physicians should recognition and prompt action. Flexible or rigid bronchoscopy via tracheostoma can successfully removal the dislodge part. The mechanism of fracture may come from several factors. The defective manufacturer, stagnation of alkaline bronchial secretion, recurrence process of removal, cleaning and boiling of the tube can cause mechanical stress and degradation of passive film of the tubes. The patient education regarding the maintenance and regular checked up can possibly extinguish this complication.