Total tracheal obliteration after intubation with a low-pressure cuffed tracheal tube

A 22-yr-old male had a head injury after a road traffic accident. His trachea was intubated for 5 days with a high-volume, low-pressure cuffed tracheal tube. When the trachea was extubated he showed signs of progressive upper airway obstruction which were relieved by tracheotomy. Computed axial tomography demonstrated complete tracheal obliteration at the previous cuff site. The patient underwent resection anastomosis of the destroyed tracheal segment which, on histological examination, showed fibrous tissue and bone formation. It is believed that excessive cuff pressure was the cause of the damage, as monitoring cuff pressure has not yet become a routine practice in anaesthesia and intensive care.