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To the Editor.—
A 58-year-old man with end-stage scleroderma was admitted with respiratory failure. The patient subsequently came to tracheostomy, which was carried out under local anesthesia without incident. A polyethylene blue-line "softseal" cuffed tube was first inflated, found to be normal, and then inserted. The patient did well for two hours, at which time his condition suddenly deteriorated. The diagnosis of tension pneumothorax was made, and he was relieved first by needle puncture, which was followed quickly by tube thoracostomy.The patient's respiratory condition improved rapidly, only to deteriorate 15 minutes later. At this point, his tracheostomy tube cuff was deflated, and he once again improved. The patient was challenged with cuff inflation only to deteriorate again.Removal of the tube disclosed a large aneurysmal dilitation. Reinflation in a simulated trachea demonstrated obstruction of the lumen by the abnormal cuff. This created, in effect, a ball-valve mechanism and may
Johnson JT, Maloney RW, Cummings CW. Tracheostomy Tube: Cuff Obstruction. JAMA. 1977;238(3):211. doi:10.1001/jama.1977.03280030019005