Pneumothorax and mediastinal emphysema following tracheotomy are apparently more common than the literature would suggest. The fact that only a few cases are reported signifies not that an accident of this type is rare but rather that it is seldom recognized. The failure to recognize pneumothorax and mediastinal emphysema often results in unnecessary death.
Reviews of large series of tracheotomies fail, for the most part, to mention pneumothorax or mediastinal emphysema. Figi,1 in reporting a series of 200 consecutive tracheotomies performed at the Mayo Clinic, made no mention of either of these conditions. Pneumothorax complicating tracheotomy has been reported by Iglauer,2 Myerson,3 Wiethe4 and Simpson.5 Leiner6 cited 9 cases of mediastinal emphysema following tracheotomy in children. After bronchoscopic procedure, pneumothorax has been reported to occur as a more frequent complication from direct perforation of the pleura.
Several anatomic factors regarding the mechanisms responsible for pneumothorax must be considered. In the
MICHELS MW. PNEUMOTHORAX AND MEDIASTINAL EMPHYSEMA COMPLICATING TRACHEOTOMY. Arch Otolaryngol. 1939;29(5):842–852. doi:10.1001/archotol.1939.00650050904006
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