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KMID : 1141320190340020161
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Kosin Medical Journal
2019 Volume.34 No. 2 p.161 ~ p.167
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Iatrogenic Tension Pneumothorax after Surgical Tracheostomy in a Child with Idiopathic Subglottic Stenosis - case report
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Park Sang-Yoong
Yim Woo-Jae
Jeong Joon-Ho
Kim Jeong-Ho
Lee Seung-Cheol
Choi So-Ron
Lee Jong-Hwan
Chung Chan-Jong
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Abstract
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Tracheostomy is increasingly performed in children for upper airway anomalies. Here, an 18-month-old child (height 84.1 cm, weight 12.5 kg) presented to the emergency department with dyspnea, stridor, and chest retraction. However, exploration of the airways using a bronchoscope failed due to subglottic stenosis. Therefore, a surgical tracheostomy was successfully performed with manual mask ventilation. However, pneumomediastinum was found in the postoperative chest radiograph. Although an oxygen saturation of 99% was initially maintained, oxygen saturation levels dropped, due to sudden dyspnea, after 3 hours. A chest radiograph taken at this time revealed a left tension pneumothorax and small right pneumothorax. Despite a needle thoracostomy, the pneumothorax was aggravated, and cardiac arrest occurred. Car-diopulmonary-cerebral resuscitation was performed, but the patient was declared dead 30 minutes later. This study high-lights the fatal complications that can occur in children during tracheostomy. Therefore, close monitoring, immediate suspicion, recognition, and aggressive management may avoid fatal outcomes.
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KEYWORD
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Pediatrics, Pneumomediastinum, Tension pneumothorax, Tracheostomy, Thoracostomy
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