Surgical tracheostomy in a patient with a stuck tracheal tube in situ

The inability to extubate a patient's trachea due to a mechanical complication is rarely encountered in clinical practice. The risks of attempting to remove a stuck tracheal tube include laryngeal trauma, vocal cord injury and arytenoid dislocation, all of which have significant implications. Here, we report the case of a patient who was admitted to the intensive care unit for mechanical ventilation following liver transplant surgery. Her trachea was initially extubated on the second postoperative day, but she required further mechanical ventilation the following day and her trachea was re-intubated. Five days later, she was deemed suitable for tracheal extubation, but the formation of granulation tissue around the tracheal tube prevented its removal. A multi-disciplinary decision-making approach was taken when deciding to site a surgical tracheostomy. A flexible bronchoscope was used as an aid for safe placement. This facilitated safe extrication of the tracheal tube, which was freed by gentle manipulation both proximally and distally. We suspect that tracheal tube size may have been a factor in the development of the granulation tissue in this case. It is important to consider tracheal tube size in all patients, particularly if they require tracheal re-intubation or are likely to require mechanical ventilation for a prolonged period.