Diagnosis by forensic autopsy of cannula malposition resulting in fatal tension pneumothorax after attempted percutaneous tracheostomy: A short communication
Diagnosis by forensic autopsy of cannula malposition resulting in fatal tension pneumothorax after attempted percutaneous tracheostomy: A short communication
复制标题
法医尸检诊断插管错位导致尝试经皮气管切开术后致命的张力性气胸：简短的交流
DOI：
10.1016/j.jflm.2021.102177
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发表时间：
2021
影响因子：
1.5
通讯作者：
Uemura Koichi
中科院分区：
文献类型：
--
作者：
Wen Shuheng;Unuma Kana;Watanabe Ryo;Uemura Koichi
经皮气管切开术通常在急诊科或重症监护室进行，以保护患者的气道。该手术并发症的发生率较低;然而，其中一些并发症（如医源性气胸）可能是致命的。经皮气管切开术后的气胸最常由气管壁穿孔或插管错位引起。一名80多岁的妇女由于持续和长时间的咳嗽被转诊到急诊室。医生推测她患有急性会厌炎，并且未能实现经口气管插管，因此进行了经皮气管切开术以保护她的气道。然而，此后立即发生进行性经皮肺气肿，患者很快死亡。死后计算机断层扫描显示双侧气胸。法医尸检显示，气管切开插管未能到达气管，并通过气管周围路径错误地插入右胸腔。因此，确定患者的死亡是由于尝试气管造口术期间插管错位引起的张力性气胸。据我们所知，这是第一个法医尸检病例报告的致命张力性气胸造成的尝试经皮气管切开术。
Percutaneous tracheostomy is commonly performed in the emergency department or intensive care unit to secure the airways of patients. This procedure is associated with a low incidence of complications; however, some of them, such as iatrogenic pneumothorax, can be fatal. Pneumothorax after percutaneous tracheostomy is most often caused by perforation of the tracheal wall or malposition of the cannula. A woman in her 80s was referred to the emergency department owing to persistent and prolonged coughing. Having speculated that she had acute epiglottitis, and having failed to achieve oral tracheal intubation, the physician performed a percutaneous tracheostomy to secure her airway. However, progressive percutaneous emphysema developed immediately thereafter, and the patient died shortly. Postmortem computed tomography showed bilateral pneumothorax. Forensic autopsy revealed that the tracheostomy cannula had failed to reach the trachea and was erroneously inserted into the right thoracic cavity via peritracheal route. Thus, it was determined that the patient's death was attributable to tension pneumothorax caused by cannula malposition during attempted tracheostomy. To the best of our knowledge, this is the first forensic autopsy case report on fatal tension pneumothorax caused by attempted percutaneous tracheostomy.