Posterior trachea wall erosion: A case report and literature review of a catastrophic complication of cuff overinflation

Abstract

Tracheostomy complications range from early to late complications. One of the late complications can be seen with cuff over-inflation that exceeds tracheal capillary perfusion pressure, which leads to segmental tracheomalacia and rarely, tracheal wall erosion. A 40-year-old male with amyotrophic lateral sclerosis and mechanical ventilation dependence was found to have a persistent ventilatory leak. Endoscopic examination revealed a large posterior tracheal wall erosion that was confirmed by computed tomography. Conservative management by the placement of a long endotracheal tube through the tracheostoma was chosen. Cuff pressure over 20-25 cm H2O, which exceeds tracheal capillary perfusion pressure, increases the risk of tracheal mucosal ischemia. Preventive strategies such as the use of pressure-limiting devices and careful tube selection, should be implemented. Regular implementation of preventive measures along with early identification are essential for avoiding tracheostomy tube complications. This case demonstrates the importance of strict cuff pressure maintenance to avoid tracheal wall injuries.