Tracheostomy related tracheal tears in pediatrics

Tracheostomy related tracheal tear is a serious complication that may follows surgical or percutaneous tracheostomy. Pediatric populations carry higher risk because of the anatomical differences. It needs immediate diagnosis as may leads to life threatening outcomes such as pneumothorax, respiratory distress, extensive subcutaneous emphysema and pneumomediastinum. The best way to diagnose and discover tracheal tear is by tracheobronchoscopy. If the diagnosis established prompt management and treatment should be performed. Objective The aim of this article is to review tracheal tears and to help in their diagnosis and management with assistance of clinical and radiological findings. Methods and Materials A literature review of PubMed , ovid Medline and cochrane collaboration databases was done using the terms pediatric , tracheostomy , tracheal tear. Discussion Tracheostomy related tracheal tear occurs infrequently and less commonly than intubation related tracheal tear. Mostly it is related to tracheostomy placement, using cuffed tubes and overinflation of the cuff or the tear directly follows traumatizing tracheostomy tube introducer insertion. The tear due to tracheostomy mostly located proximal to carina and distal to insertion of point of tracheostomy. Symptoms and complications of the tear may occur intraopertivly or postoperatively(5). Gold standard method for diagnosis will be established by flexible or rigid tracheobronchoscopy which helps in determining the site, size, extension of the tear and its location with respect to the carina that are essential to document. Imaging studies like CT scan which also helps in establishing the diagnosis of tear and some of it is complications such as pneumothorax, pneumonia, pneumomediastinum and mediastinitis. Treatment can be conservative for small uncomplicated wound in stable patient. For larger complicated tears and unstable patient surgical treatment is the gold standard. Conclusion Treatment choices depend on tear site , size, extension of the tear and the status of the patient. Conservative management is sufficient for stable patients with small tears . On the other hand , surgical management is essential for unstable patients and large complicated wounds.