Abstract
Introduction
Percutaneous dilatational tracheotomy (PDT) is becoming increasingly popular in present day critical care medicine. In contrast to the surgical approach, PDT involves a blind puncture and dilation of the pretracheal space, which may predispose to dangerous complications in the case of anatomical, in particular vascular, anomalies.
Methods and Results
We report on two patients, in whom an abnormal pulsation was detected when the infracricoid region was palpated in preparation for PDT. An immediately performed ultrasound scan revealed an arterial blood vessel in front of the upper part of the trachea. A subsequent CT-angiography showed an anomalous course of the brachiocephalic trunk. While too dangerous for PDT, the local department of cranio-maxillofacial surgery was consulted for surgical tracheotomy.
Conclusion
To avoid hazardous bleeding complications in PDT we recommend at least an ultrasound scan in case of an abnormal pulsation and an enlarged thyroid gland.
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References
Nieszkowska A, Combes A, Luyt CE, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005;33:2527–33. doi:10.1097/01.CCM.0000186898.58709.AA.
Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies on the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ. 2005;1243. doi:10.1136/bmj.38467.485671.E0.
Dziewas R, Ritter M, Schilling M, et al. Pneumonia in acute stroke patients fed by nasogastric tubes. J Neurol Neurosurg Psychiatry. 2004;75:852–6. doi:10.1136/jnnp.2003.019075.
Warnecke T, Dziewas R, Oelenberg S, et al. Serial fiberoptic examination of swallowing in patients with acute stroke and dysphagia: case report and general considerations. J Stroke Cerebrovasc Dis. 2006;15:172–5. doi:10.1016/j.jstrokecerebrovasdis.2006.05.001.
Shelden C, Pudenz R. Percutaneous tracheotomy. J Am Med Assoc. 1957;165:2068–70.
Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest. 1985;87:715–9. doi:10.1378/chest.87.6.715.
Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care. 2006;10:R55. doi:10.1186/cc4887.
Schaefer OP, Irwin RS. Tracheoarterial fistula: an unusual complication of tracheotomy. J Intensive Care Med. 1995;10:64–7.
Allan JS, Wright CD. Tracheoinnominate fistula: diagnosis and management. Chest Surg Clin N Am. 2003;13:331–41. doi:10.1016/S1052-3359(03)00006-1.
Grant CA, Dempsey G, Harrison J, Jones T. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review. Br J Anaesth. 2006;96:127–31. doi:10.1093/bja/aei282.
Nelems JM. Tracheo-innominate artery fistula. Am J Surg. 1981;141:526–7. doi:10.1016/0002-9610(81)90038-6.
Omar MA, Griffiths MV. Aortic arch laceration: a lethal complication after percutaneous tracheostomy. Laryngoscope. 2007;117:176–8. doi:10.1097/01.mlg.0000244181.01612.a6.
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J. Minnerup and O. Summ contributed equally to this study.
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Minnerup, J., Summ, O., Oelschlaeger, C. et al. When Percutaneous Dilation Tracheotomy Maybe Hazardous: Abnormal Course of the Brachiocephalic Trunk. Neurocrit Care 10, 336–338 (2009). https://doi.org/10.1007/s12028-009-9210-3
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DOI: https://doi.org/10.1007/s12028-009-9210-3