Academic Journal
Secondary Pneumomediastinum Following Bronchoscopic Interventions in Patients With Prolonged Tracheostomy Intubation: A Case Series.
| Τίτλος: | Secondary Pneumomediastinum Following Bronchoscopic Interventions in Patients With Prolonged Tracheostomy Intubation: A Case Series. |
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| Συγγραφείς: | Pengcheng L; Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China., Tao F; Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China., Qing Z; Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China., Peng Z; Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China., Na C; Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China., Fangming T; Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China., Qiuyou X; Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China. |
| Πηγή: | The American journal of case reports [Am J Case Rep] 2026 Jul 24; Vol. 27, pp. e952567. Date of Electronic Publication: 2026 Jul 24. |
| Τύπος έκδοσης: | Journal Article; Case Reports |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: International Scientific Information, Inc Country of Publication: United States NLM ID: 101489566 Publication Model: Electronic Cited Medium: Internet ISSN: 1941-5923 (Electronic) Linking ISSN: 19415923 NLM ISO Abbreviation: Am J Case Rep Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2014- > : Smithtown, NY : International Scientific Information, Inc. Original Publication: Albertson, NY : International Scientific Literature, Inc. |
| Ιατρικοί όροι (MeSH): | Mediastinal Emphysema*/etiology , Mediastinal Emphysema*/therapy , Mediastinal Emphysema*/diagnostic imaging , Tracheostomy*/adverse effects , Bronchoscopy*/adverse effects , Intubation, Intratracheal*/adverse effects, Subcutaneous Emphysema/etiology ; Humans ; Male ; Adult ; Aged ; Young Adult ; Tomography, X-Ray Computed ; Time Factors |
| Περίληψη: | BACKGROUND Tracheostomy is a cornerstone of long-term intensive care, utilized in approximately 15% of intensive care unit patients. While beneficial, prolonged tracheostomy intubation initiates structural changes within the tracheal architecture, predisposing patients to severe late-stage complications, including secondary pneumomediastinum, which can rapidly progress to tension physiology and obstructive shock. Specific triggers, pathophysiological pathways (eg Macklin effect vs direct disruption), and multi-compartment air tracking in tracheostomized populations remains incompletely understood. This report seeks to guide early prevention and emergency management by describing chronological clinical presentations, diagnostic decision-making, and therapeutic outcomes of complications in 3 prolonged-tracheostomy patients. CASE REPORT Three male patients underwent prolonged tracheostomy intubation (>1 month) and developed pneumomediastinum following airway manipulation. A 38-year-old patient developed severe subcutaneous emphysema (SE) 48 hours post-decannulation following tracheal polypectomy. Computed tomography (CT) ruled out tension pneumothorax, and stable hemodynamics justified successful conservative management. A 69-year-old patient experienced sudden dyspnea and SE during bedside bronchoscopy. CT revealed extensive soft-tissue gas and left-sided pneumothorax, requiring an emergency bedside subcutaneous incision and closed chest drainage due to rapid respiratory deterioration. A 19-year-old patient developed rapidly spreading SE and progressed to cardiac arrest during a bronchoscopic polypectomy. Malignant tension pneumomediastinum ensued following massive gas entry, severely obstructing venous return, which proved fatal despite advanced life support. CONCLUSIONS Secondary pneumomediastinum during airway manipulation demands a high index of clinical suspicion. While stable cases resolve conservatively, rapid gas accumulation causes obstructive shock requiring immediate thoracic decompression. Strict preoperative cough suppression and continuous cuff pressure monitoring are critical preventative strategies. |
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| Entry Date(s): | Date Created: 20260724 Date Completed: 20260724 Latest Revision: 20260813 |
| Update Code: | 20260814 |
| PubMed Central ID: | PMC13410793 |
| DOI: | 10.12659/AJCR.952567 |
| PMID: | 42497110 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1941-5923 |
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| DOI: | 10.12659/AJCR.952567 |