Education  |   November 2018
Extreme Trachea Dilatation after Prolonged Ventilation at High Tracheal Cuff Pressure
Author Notes
  • From the Department of Anesthesiology, St. Marco Hospital, Beijing, China (Y.L.M.); the Departments of Anesthesiology (Y.L.M., Y.L.) and Respiratory Medicine (R.J.W.), PLA 306 Hospital, Beijing, China; and the Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital (J.W.), Beijing, China.
  • Address correspondence to Dr. J. Wang: wangjingdoc@126.com
Article Information
Education / Images in Anesthesiology / Respiratory System / Technology / Equipment / Monitoring
Education   |   November 2018
Extreme Trachea Dilatation after Prolonged Ventilation at High Tracheal Cuff Pressure
Anesthesiology 11 2018, Vol.129, 1027. doi:10.1097/ALN.0000000000002370
Anesthesiology 11 2018, Vol.129, 1027. doi:10.1097/ALN.0000000000002370
A 65-YR-OLD woman with chronic obstructive pulmonary disease and pulmonary fibrosis was intubated in the intensive care unit with a high-volume, low-pressure, polyvinyl, chloride-cuffed endotracheal tube (internal diameter 7.5). Subsequent tracheotomy was refused and on the 94th day of ventilation, computed tomography of the thorax was performed and identified the tracheal dilation at the site of the endotracheal tube cuff (53 × 47 mm; panels A, B). On the 104th day of ventilation, a tracheoesophageal fistula was discovered at the site of the cuff by bronchofiberscope. The patient died of multiple organ failure on the 204th day of ventilation. The endotracheal tube cuff pressure was never monitored, and the presence of chronic obstructive pulmonary disease and pulmonary fibrosis necessitated high inspiratory pressure (30 to 40 cm H2O) for much of her intensive care unit stay.