Clinical Case: Micro-drainage of subcutaneous emphysema Grade V through a fenestrated peripheral venous catheter in critical ill
Main Article Content
Keywords
Subcutaneous Emphysema, Catheters, Tracheostomy
Abstract
Background: Approximately 30% of surgical procedures in the United States require orotracheal intubation. Generally laryngeal and tracheal injuries are rare. However, when they do occur, they can lead to major complications. Subcutaneous emphysema is the most common clinical presentation and is mostly treated conservatively and self-limiting. However, when it is Grade V, control strategies should be considered. There are reports in the literature on micro-drainage of subcutaneous emphysema through a fenestrated peripheral venous catheter with satisfactory results.
Clinical case: We present the case of a 69-year-old diabetic man with hypertension and a history of pulmonary thromboembolism. He presented with a Grade II tracheal injury and Grade V subcutaneous emphysema. Micro-drainage of subcutaneous emphysema was performed through a size 14 peripheral venous catheter with fenestration, with adequate results.
Conclusions: The peripheral venous catheter for microdrainage is a minimally invasive option for the treatment of grade V subcutaneous emphysema associated with tracheal injury. It can be a conservative strategy and, in some cases, can avoid the need for major interventions.
References
1. Bicket MC, Chua KP, Lagisetty P, et al. Prevalence of Surgery Among Individuals in the United States. Annals of Surgery Open. 2024;5(2):e421. doi: 10.1097/as9.0000000000000421
2. Brodsky MB, Akst LM, Jedlanek E, et al. Laryngeal Injury and Upper Airway Symptoms After Endotracheal Intubation During Surgery: A Systematic Review and Meta-analysis. Anesth Analg.Lippincott Williams and Wilkins. 2021;132(4):1023-1032. doi: 10.1213/ANE.0000000000005276
3. Badia M, Montserrat N, Serviá L, et al. Complicaciones graves en la intubación orotraqueal en cuidados intensivos: Estudio observacional y análisis de factores de riesgo. Med Intensiva. 2015;39(1):26-33. doi: 10.1016/j.medin.2014.01.003
4. Brodsky MB, Levy MJ, Jedlanek E, et al. Laryngeal injury and upper airway symptoms after oral endotracheal intubation with mechanical ventilation during critical care: A systematic review. Crit Care Med. 2018;46(12):2010-2017. doi: 10.1097/CCM.0000000000003368
5. Miles ET, Cook T. Critical incidents: the respiratory system. Anaesthesia and Intensive Care Medicine. 2019;(20):687-692.
6. Gómez-Caro A, Ausín P, Moradiellos FJ, et al. Role of conservative medical management of tracheobronchial injuries. Journal of Trauma - Injury, Infection and Critical Care. 2006;61(6):1426-1434. doi: 10.1097/01.ta.0000196801.52594.b5
7. Melhorn J, Davies HE. The Management of Subcutaneous Emphysema in Pneumothorax: A Literature Review. Curr Pulmonol Rep. 2021;10:92-97. doi: 10.1007/s13665-021-00272-4/Published
8. Schneider T, Storz K, Dienemann H, Hoffmann H. Management of Iatrogenic Tracheobronchial Injuries: A Retrospective Analysis of 29 Cases. Annals of Thoracic Surgery. 2007;83(6):1960-1964. doi: 10.1016/j.athoracsur.2007.01.042
9. Ozdogan M, Guerra A, Kaan Goghus A, Gogkus S, Aydin R. Treatment of severe subcutaneous emphysema by fenestrated angiocatheter. Intensive Care Med. 2005;(31):168. doi: 10.1007/s00134-004-2443-x
10. Lampl L. Tracheobronchial injuries. Conservative treatment. Interact Cardiovasc Thorac Surg. 2004;3(2):401-405. doi: 10.1016/j.icvts.2004.02.016
11. Grewal HS, Dangayach NS, Ahmad U, Ghosh S, Gildea T, Mehta AC. Treatment of Tracheobronchial Injuries: A Contemporary Review. Chest.Elsevier Inc. 2019;155(3):595-604. doi: 10.1016/j.chest.2018.07.018
12. Rasiah S, Whitchurch M. Severe Subcutaneous Emphysema. New England Journal of Medicine. 2022;387(9). doi: 10.1056/nejmicm2200611
13. Polistena A, Puma F, Avenia N, Vanucci J. Tracheal Injury. In: Testini M, Gurrado A, eds. Thyroid Surgery. Vol 1. 1st ed. Springer; 2024:161-170. doi: 10.1007/978-3-031-31146-8
14. Welter S, Essaleh W. Management of tracheobronchial injuries. J Thorac Dis.AME Publishing Company. 2020;12(10):6143-6151. doi: 10.21037/jtd-2019-as-05
15. Cardillo G, Carbone L, Carleo F, et al. Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment. European Journal of Cardio-thoracic Surgery. 2010;37(3):581-587. doi: 10.1016/j.ejcts.2009.07.034
16. Aghajanzadeh M, Dehnadi A, Ebrahimi H, et al. Classification and Management of Subcutaneous Emphysema: a 10-Year Experience. Indian Journal of Surgery. 2015;77:673-677. doi: 10.1007/s12262-013-0975-4
17. Jorge N, Costa L, Teixeira S, Silva-Pinto A, Paiva J. Tracheal Rupture After Trauma: A Successful Conservative Management. Cureus. Published online December 19, 2022. doi: 10.7759/cureus.32681
18. Beck PL, Heitman SJ, Mody CH. Simple construction of a subcutaneous catheter for treatment of severe subcutaneous emphysema. Chest. 2002;121(2):647-649. doi: 10.1378/chest.121.2.647
19. Leo F, Solli P, Veronesi G. Efficacy of Microdrainage in Severe Subcutaneous Emphysema. Chest. Published online October 4, 2022.
20. Matsushita T, Huynh AT, Singh T, Thomson D. Management of Life-threatening Subcutaneous Emphysema Using Subcutaneous Penrose Drains and Colostomy Bags. Heart Lung Circ. 2007;16(6):469-471. doi: 10.1016/j.hlc.2006.08.005
21. Oweidat M, Al Jada I, Alhroub W, Shubietah A, Humeedat M. Micro-drainage for management of extensive subcutaneous emphysema: A case report. Surgery Cae Reports. 2025;4:100085. doi: 10.1016/j.sycrs.2024.100085
Article Sidebar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.