key: cord-0712831-a46znu4l
authors: Stangoe, D.; Nikolaou, K.; Townsend, J.
title: Tracheostomy obstruction refractory to conventional management strategies
date: 2021-05-17
journal: Anaesth Rep
DOI: 10.1002/anr3.12108
sha: 8037406e5390f6c60fbe73e233197fe0940e4973
doc_id: 712831
cord_uid: a46znu4l

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on account of minimal compliance, and her peripheral oxygenation saturations steadily worsened to 60%. Ora-tracheal intubation was expeditiously undertaken whereupon oxygenation saturations immediately recovered. The tracheostomy tube had a secretory mass adherent to it which underwent dynamic 'ball-valve' obstruction upon continued passage of a catheter (Fig 1, Video 1 ).

Ball-valve obstruction tends to result in partial obstruction with pulmonary haemorrhage leading to hyperinflation and tension effects [2] [3] [4] . Its occurrence has been reported previously, albeit rarely [2, 3] , and ours is not the only case of failure to resolve with passage of a catheter as advocated in established multidisciplinary guidance [1] . However, to our knowledge, this is the only report of a catheter causing displacement and replacement of the obstruction directly, rather than resolution of airflow.

This case demonstrates that algorithms may not account for every possible scenario. Had tracheostomy obstruction been excluded on account of successful catheter passage as the aforementioned guideline suggests, the patient may have gone into cardiac arrest. Trans-tracheostomy bronchoscopy would have revealed the diagnosis and we would thus advocate this, rather than sole reliance on catheter passage to exclude obstruction.

Multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies

Dynamic airway obstruction from a circumferential mass with a free-floating projection: a subacute complication of percutaneous tracheostomy

Case report: a ball valve blood clot in the airways -life-saving whole tube suction

Fatal endotracheal tube obstruction due to the ball valve effect

Published with the written consent of the patient. No external funding or competing interests declared.