Rarely intubation can result in tracheal rupture.
Risk factors:
(1) multiple forced intubation attempts
(2) emergency intubation
(3) clinical inexperience
(4) incorrect tube tip position
(5) inappropriate tube size
(6) protruding tracheal tube guide
(7) repositioning of the tube with inflated cuff
(8) tracheal anomaly
(9) chronic steroid use
(10) COPD
(11) advanced age
(12) female sex
(13) short stature
The rupture may be a direct perforation or a longitudinal tear.
Clinical findings are affected by size and location:
(1) subcutaneous emphysema
(2) pneumomediastinum
(3) instability
(4) respiratory insufficiency
(5) mediastinitis
(6) esophageal trauma
The diagnosis can be made by imaging studies or endoscopy.
Surgical repair is usually indicated if there is a large tear with air leak and clinical instability. Some patients may require tracheostomy while others can be managed conservatively.
The patient needs to be monitored for complete healing and the presence of any stenosis.
