SQ emphysema after endotracheal intubation

Case: 53 years old patient was intubated in the ICU without any complications. CXR showed an ETT in the right mainstem. Provider pulled the ETT by 3 cm. After adjustment, the patient developed significant SQ emphysema along with periorbital swelling. Almost all cases of postintubation tracheal laceration are reported in? - select one

A) Short female patients

B) Tall male patients

Answer: A

Tracheal tear due to repositioning of the tube without cuff deflation 

Tracheobronchial laceration is a potentially serious complication of endotracheal intubation. It can occur following uneventful intubation. Most injuries are in the lower third of the trachea.

Most common causes include:

• Overinflation of the cuff, resulting in necrosis of the mucosa after prolonged intubation
• Repositioning of the tube without cuff deflation (as may have occurred in the above case)
• Patient movement
• A sudden increase in the intratracheal pressure caused by vigorous coughing in the presence of the endotracheal tube
• Inappropriate tube size
• COPD
• Conditions associated with a weakness of the membranous trachea (eg, elderly patient, steroid therapy)
• Mucosal erosion or perforation of the anterior cartilaginous tracheal wall from the tip of the tube or the stylet.

Interestingly, almost all cases of postintubation tracheal laceration are reported in short female patients.

#procedures

References:

1. A 63-Year-Old Woman With Subcutaneous Emphysema Following Endotracheal Intubation - Chest. 2005;128:434-438

2. Sakamoto A, Kogou Y, Matsumoto N, Nakazato M. Massive subcutaneous emphysema and pneumomediastinum following endotracheal intubation. Intern Med. 2013;52(15):1759. doi: 10.2169/internalmedicine.52.0575. Epub 2012 Mar 1. PMID: 23903518.