Scientific Letter
Acute Respiratory Distress due to Post-tracheostomy Tracheal Rupture Treated With Venovenous Extracorporeal Membrane Oxygenation and Endotracheal Prosthesis
Síndrome de distrés respiratorio agudo secundario a rotura traqueal postraqueostomía tratado con membrana de oxigenación extracorpórea venovenosa y prótesis endotraqueal
M. Teresa Gómez-Hernández
, María Rodríguez-Pérez, Gonzalo Varela-Simó
Corresponding author
Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
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Teresa Gómez-Hernández, María Rodríguez-Pérez, Gonzalo Varela-Simó" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M. Teresa" "apellidos" => "Gómez-Hernández" "email" => array:1 [ 0 => "mteresa.gomez.hernandez@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Rodríguez-Pérez" ] 2 => array:2 [ "nombre" => "Gonzalo" "apellidos" => "Varela-Simó" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Síndrome de distrés respiratorio agudo secundario a rotura traqueal postraqueostomía tratado con membrana de oxigenación extracorpórea venovenosa y prótesis endotraqueal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 543 "Ancho" => 1957 "Tamanyo" => 95537 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) CT image, showing significant subcutaneous emphysema and pneumomediastinum. (B) Portable chest X-ray showing subcutaneous emphysema, bilateral alveolar-interstitial infiltrate and selective right intubation. (C) Portable chest X-ray, several days after placement of tracheal stent.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 36-year-old man with a history of mild mental retardation and esophageal atresia with tracheoesophageal fistula operated at birth, who was admitted to the intensive care unit with symptoms of intestinal obstruction, probably caused by medications, and generalized respiratory failure caused by bronchoaspiration, requiring orotracheal intubation (OTI).</p><p id="par0010" class="elsevierStylePara elsevierViewall">Twelve days after admission, percutaneous dilatational tracheostomy was performed. Forty-eight hours after the procedure, the patient presented significant subcutaneous emphysema and pneumomediastinum (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), so the tracheal cannula was removed and the patient was reintubated. The patient's general condition worsened progressively, with respiratory acidosis, hypercapnia >100<span class="elsevierStyleHsp" style=""></span>mmHg, PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> <200<span class="elsevierStyleHsp" style=""></span>mmHg, severe respiratory difficulties, and incipient arterial hypertension. The chest X-ray showed bilateral alveolar-interstitial infiltrates and bronchoscopy revealed a 2<span class="elsevierStyleHsp" style=""></span>cm rupture in the distal third of the trachea. The lesion was situated at the end of the orotracheal tube, so the tube was advanced with the fiberoptic bronchoscope until the distal end was in the right main bronchus (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Despite this maneuver, the patient's poor respiratory status, consistent with acute respiratory distress syndrome (ARDS) persisted, so we decided to administer support therapy with venovenous extracorporeal membrane oxygenation (VV-ECMO). After the patient's hemodynamic and respiratory situation stabilized, a self-expanding fully-coated nitinol tracheal stent was placed and the orotracheal tube was relocated to the site of the stent, re-establishing bipulmonary ventilation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). After 13 days of support, ECMO was withdrawn and bronchoscopy-guided tracheostomy was performed. The patient remained stable and was discharged, almost 3 months after admission, after withdrawal of the cannula and removal of the stent by bronchoscopy.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Tracheobronchial lesions caused by tracheostomy are rare, occurring at a rate of around 0.2%–0.7%.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In our case, the procedure may have been complicated by the patient's history of repaired distal tracheoesophageal fistula and the resulting distortion of the tracheal pars membranosa in this region, increasing the chance of injury. Self-expanding prostheses are a useful therapeutic option, particularly in patients with a high surgical risk, or in those in whom conservative treatment is ineffective.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">ARDS is associated with a mortality of 45%–55%.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> A protective pulmonary ventilation strategy using low tidal volumes and prone positioning of the patient are the only therapeutic measures shown to improve survival.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In this context, ECMO-VV support provides good oxygenation and ventilation, therefore minimizing ventilatory support and barotrauma associated with mechanical ventilation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Our patient's situation was complicated by lesions caused by aspiration, and we found it impossible to keep him properly ventilated, so lung function support with VV-ECMO was required before the tracheal stent could be placed. This case demonstrates the benefit of ECMO in the management of patients with ARDS, and its utility as a bridge to the definitive treatment of tracheal rupture.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez-Hernández MT, Rodríguez-Pérez M, Varela-Simó G. Síndrome de distrés respiratorio agudo secundario a rotura traqueal postraqueostomía tratado con membrana de oxigenación extracorpórea venovenosa y prótesis endotraqueal. Arch Bronconeumol. 2016;52:337–338.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 543 "Ancho" => 1957 "Tamanyo" => 95537 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) CT image, showing significant subcutaneous emphysema and pneumomediastinum. (B) Portable chest X-ray showing subcutaneous emphysema, bilateral alveolar-interstitial infiltrate and selective right intubation. (C) Portable chest X-ray, several days after placement of tracheal stent.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic percutaneous dilatational tracheotomy: a prospective evaluation of 500 consecutive cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.M. 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Thalanany" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(09)61069-2" "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2009" "volumen" => "374" "paginaInicial" => "1351" "paginaFinal" => "1363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19762075" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005200000006/v1_201605260126/S1579212916300404/v1_201605260126/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000006/v1_201605260126/S1579212916300404/v1_201605260126/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916300404?idApp=UINPBA00003Z" ]
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| 2021 June | 32 | 32 | 64 |
| 2021 May | 42 | 37 | 79 |
| 2021 April | 101 | 92 | 193 |
| 2021 March | 51 | 20 | 71 |
| 2021 February | 29 | 19 | 48 |
| 2021 January | 47 | 14 | 61 |
| 2020 December | 33 | 12 | 45 |
| 2020 November | 35 | 15 | 50 |
| 2020 October | 41 | 16 | 57 |
| 2020 September | 27 | 15 | 42 |
| 2020 August | 30 | 15 | 45 |
| 2020 July | 30 | 22 | 52 |
| 2020 June | 29 | 4 | 33 |
| 2020 May | 50 | 16 | 66 |
| 2020 April | 47 | 20 | 67 |
| 2020 March | 36 | 16 | 52 |
| 2020 February | 42 | 28 | 70 |
| 2020 January | 41 | 27 | 68 |
| 2019 December | 42 | 13 | 55 |
| 2019 November | 25 | 19 | 44 |
| 2019 October | 22 | 8 | 30 |
| 2019 September | 27 | 11 | 38 |
| 2019 August | 29 | 9 | 38 |
| 2019 July | 30 | 20 | 50 |
| 2019 June | 27 | 14 | 41 |
| 2019 May | 44 | 16 | 60 |
| 2019 April | 34 | 37 | 71 |
| 2019 March | 33 | 24 | 57 |
| 2019 February | 36 | 22 | 58 |
| 2019 January | 35 | 14 | 49 |
| 2018 December | 38 | 17 | 55 |
| 2018 November | 62 | 17 | 79 |
| 2018 October | 72 | 13 | 85 |
| 2018 September | 36 | 20 | 56 |
| 2018 May | 28 | 0 | 28 |
| 2018 April | 30 | 7 | 37 |
| 2018 March | 53 | 4 | 57 |
| 2018 February | 36 | 4 | 40 |
| 2018 January | 128 | 9 | 137 |
| 2017 December | 117 | 5 | 122 |
| 2017 November | 34 | 3 | 37 |
| 2017 October | 22 | 5 | 27 |
| 2017 September | 20 | 7 | 27 |
| 2017 August | 24 | 8 | 32 |
| 2017 July | 23 | 4 | 27 |
| 2017 June | 30 | 16 | 46 |
| 2017 May | 29 | 12 | 41 |
| 2017 April | 30 | 48 | 78 |
| 2017 March | 19 | 12 | 31 |
| 2017 February | 16 | 7 | 23 |
| 2017 January | 7 | 3 | 10 |
| 2016 December | 27 | 8 | 35 |
| 2016 November | 38 | 20 | 58 |
| 2016 October | 52 | 17 | 69 |
| 2016 September | 28 | 3 | 31 |
| 2016 August | 1 | 0 | 1 |
Show all
