Cardiac arrest due to an unexpected inability to ventilate in a tracheostomy patient suggesting the need for a routine anesthesia checklist and an anesthesia relevant emergency pathway for tracheostomy management: a case report.
Cardiac arrest due to an unexpected inability to ventilate in a tracheostomy patient suggesting the need for a routine anesthesia checklist and an anesthesia relevant emergency pathway for tracheostomy management: a case report.
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DOI：
10.21037/atm-23-1834
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发表时间：
2023-12-20
影响因子：
--
通讯作者：
Eckle, Tobias
中科院分区：
文献类型：
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作者：
Villasenor, Mario;Bengson, Jeremy;Cloyd, Benjamin H;Eckle, Tobias
全世界高达30%的患者存在与气管切开术相关的严重并发症。我们报告了一个病例，由于预先存在脑损伤的患者意外的气道阻塞，导致心脏骤停的“无法呼吸”事件。以下病例报告是独特的，因为患者在冠状病毒病19（COVID-19）感染后出现了粘液栓，变成了晶体。患者是一名年轻人，因机动车碰撞而遭受创伤性脑损伤。他提出选择性膀胱镜检查，以治疗复发性尿路感染。在麻醉诱导期间，患者变得激动、饱和度降低，无法进行通气。在胸外按压的情况下，气管切开术被移除，患者使用视频喉镜快速并成功地进行了口腔插管。随后对气管切开插管进行检查，发现远端部分有一个粘液栓，其已硬化成岩石状外观。内套管也丢失。随访显示，该患者最近发生了COVID-19感染，因此其气管切开插管的抽吸频率较低。回顾文献，我们认识到没有病例报告记录粘液栓变成结石。回顾处理气管切开紧急情况的指南，我们认识到美国没有麻醉特定指南。我们也认识到，没有为接受手术的气管造口术患者制定检查清单。因此，我们建议建立一个常规的检查表和麻醉的具体指南，紧急情况下，遵循每一个病人进行气管切开手术。
Up to 30% of patients worldwide have a significant complication related to their tracheostomy. We report a case of a ‘cannot ventilate’ event resulting in cardiac arrest due to an unexpected airway occlusion in a patient with a pre-existing brain injury The following case report is unique as the patient had developed a mucus plug that turned into a crystal following a coronavirus disease 19 (COVID-19) infection. The patient was a young adult who suffered a traumatic brain injury from a motor vehicle collision. He presented for elective cystoscopy to treat recurrent urinary tract infections. During induction of anesthesia, the patient became agitated, desaturated, and ventilation became impossible. With chest compressions underway the tracheostomy was removed, and the patient was quickly and successfully orally intubated using a video-laryngoscope. Subsequent inspection of the tracheostomy tube revealed a mucus plug in the distal portion which had hardened into a rock-like appearance. The inner cannula was also missing. Follow-up revealed that the patient recently had a COVID-19 infection and because of this received less frequent suctioning of his tracheostomy tube. Reviewing the literature, we recognized that there has been no case report documenting a mucus plug that turned into a stone. Reviewing guidelines for handling tracheostomy emergencies, we recognize that there are no anesthesia specific guidelines in the USA. We also recognize that there are no established checklists for patients with tracheostomy undergoing surgery. We therefore recommend establishing a routine checklist and anesthesia specific guideline for emergencies that follows every patient with a tracheostomy undergoing surgery.