Two Cases of Bilateral Pneumothorax after Tracheostomy

Abstract

Tracheostomy is one of the most commonly performed procedures in the clinical field. Despite its frequent use, the tracheostomy procedure is not free of severe, and, in some cases devastating, complications. In fact, severe adverse events, such as pneumomediastinum, pneumothorax, hemorrhage, infections, and, occasionally, death, have been described. We experienced two cases of bilateral pneumothorax after emergency tracheostomy for acute epiglottitis and airway narrowing due to suspected thyroid cancer invasion of the trachea. Intraoperative pain on breathing with violent coughing aggravated the pneumothorax in our two cases, and consequently the SpO2 value deteriorated. We cut the tracheal wall and cannula insertion was performed. After that we performed positive pressure ventilation. However, respiratory impairment and degradation of SpO2 levels persisted and subcutaneous emphysema was appeared. We confirmed the subcutaneous emphysema, mediastinal emphysema, bilateral pneumothorax radiographically. The mechanism underlying the pneumothorax was thought to be extreme negative intrathoracic pressure induced by labored breathing and forced ventilation drawing air into the mediastinum and thorax. It is important to consider the development of pneumothorax when respiratory impairment and degradation of SpO2 levels persist, and subcutaneous emphysema appears immediately after tracheostomy.