Fatal Tension Pneumopericardium Complicating Tracheostomy

doi:10.1378/chest.73.1.107

Chest

Volume 73, Issue 1, January 1978, Pages 107-109

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The findings in a patient who developed a fatal pneumopericardium following tracheostomy are reported. This complication of tracheostomy does not appear to have been reported previously in the literature. When recognized, pneumopericardium is a treatable lesion, and clinicians should be aware of this potential complication.

Section snippets

Case Report

A 62-year-old black man was transferred to Sacramento Medical Center of the University of California, Davis, nine days after an auto accident in which he suffered a fractured pelvis, fractures of multiple ribs, and a cervical fracture with a resulting sixth cervical sensorimotor loss. Care at the referring hospital included splenectomy and stabilization of the patient's cervical spine. Continuous ventilatory support became necessary, with the early onset of the “shock lung” syndrome. The

Discussion

Tracheostomy is commonly regarded as a simple operation, with serious complication occurring only rarely. These usually have been associated with prolonged inflation of cuffs in patients receiving mechanical ventilation and included erosion of the innominate artery and the development of tracheoesophageal fistulae. To our knowledge, tension pneumopericardium as a complication has not been described previously, although pneumothorax, pneumomediastinum, and subcutaneous emphysema occur frequently

References (7)

TM Toledo et al.
Spontaneous pneumopericardium in acute asthma: Case report and review of the literature
Chest
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IF Padovan et al.
Pathogenesis of mediastinal emphysema and pneumothorax following tracheostomy
Chest
(1974)
W McCaughery et al.
Pneumopericardium associated with tracheal rupture
Anesthesia
(1975)

There are more references available in the full text version of this article.

Cited by (6)

Air in the pericardial sac post tracheostomy: One should be aware
2016, Journal of Acute Medicine
Citation Excerpt :
Pneumopericardium had been reported as a consequence of chest trauma, positive pressure ventilation, pericardial infection, communicating fistula in the pericardial sac and secondary to a complication from invasive procedures.1,2 It was reported that isolated pneumopericardium, without associated mediastinal air is a possible complication after tracheostomy.3 The loosely applied pretracheal fascia at the lateral wall of trachea is in continuation with the fibrous layer of the parietal pericardium.
Pneumopericardium is a rare clinical presentation and is an unusual complication of tracheostomy. Its isolated presentation without associated air in other potential space such as mediastinum or pleura causes difficulty in diagnosis especially in patient with invasive ventilation. We report a case of 72-year-old lady who developed isolated pneumopericardium following tracheostomy. The progression into cardiac tamponade was halted by administration of fluid resuscitation and modifying ventilation mode to spontaneous setting. A flexometallic endotracheal tube was inserted through the tracheostomy stoma with the aid of fibre-optic scope while she was breathing spontaneously; and the cuff was inflated distal to the site of the tracheal wall injury. This technique successfully ceased the air leak across the injury. The endotracheal tube was changed to an adjustable flange tracheostomy tube size 8.5mm internal diameter once available and subsequent serial chest radiographs showed resolving pneumopericardium. Based on this case, we believed that a prompt diagnosis of isolated pneumopericardium may prevent its catastrophic progression into a fatal cardiac tamponade and thus, these rare findings were reported with the intention to raise awareness amongst clinicians.
Tension pneumopericardium as a complication of single-lung transplantation
1990, The Annals of Thoracic Surgery
Tension pneumopericardium following blunt chest trauma
1985, Annals of Emergency Medicine
A 12-year-old victim of an automobile-pedestrian accident appeared to develop severely compromised cardiac output shortly after intubation and positive pressure ventilation. Anteroposterior and lateral chest films showed air within the pericardial sac. After pericardiocentesis and withdrawal of air, cardiac function improved markedly as evidenced by a rise in blood pressure and a slowing of the pulse. A catheter was left in the pericardial sac for several days. The patient remained hemodynamically stable throughout the hospital stay and was subsequently discharged. Documentation of this degree of tamponade from air in the pericardium is quite uncommon.
Tracheostomy
2011, General Thoracic Surgery: Seventh Edition
Pulmonary Barotrauma in the Intensive Care Unit
1988, Journal of Intensive Care Medicine
Postpartum pneumopericardium
1983, Obstetrics and Gynecology

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Chest

Selected ReportsFatal Tension Pneumopericardium Complicating Tracheostomy

Section snippets

Case Report

Discussion

Chest

Chest

Pneumopericardium associated with tracheal rupture

Anesthesia

Selected Reports
Fatal Tension Pneumopericardium Complicating Tracheostomy