Management of post-intubation tracheal membrane ruptures: A practical approach
A 69-year-old female was admitted with coma following a mixed overdose of benzodiazepines and narcotics. She was intubated, using an ETT with stylet.\nPersistent leak around her ETT, despite cuff inflation and tube changes initiated bronchoscopy. A 7 cm posterior tracheal tear extending to 2 rings above the carina contained large thrombus and mucopus. The ETT was withdrawn to above the proximal extent of the defect and meropenem for suspected mediastinitis (penicillin allergy).\nThoracic surgical consultation was sought due to the size and length of the defect, the potential for failure of bridging, and the chance of mediastinitis. Conservative management was advised, unless active endobronchial bleeding or progressive ventilatory failure ensued. A protective ventilation strategy, avoidance of blind tracheal suctioning and cluster care to avoid excessive ETT movement on patient repositioning were adopted. Bronchoscopy allowed airway clearance and monitoring of the defect. Spontaneous healing occurred, allowing tracheostomy, weaning, and discharge at 1 month.