This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Web of Science (5) Citing Articles via Google Scholar Google Scholar Articles by Scherrer, E. Articles by Dhonneur, G. Search for Related Content PubMed PubMed Citation Articles by Scherrer, E. Articles by Dhonneur, G. Related Collections Critical Care Airway

---

CRITICAL CARE AND TRAUMA

Tracheal Ring Fracture During a PercuTwist Tracheostomy Procedure

From the Department of Anesthesiology and Intensive Care Medicine, Henri Mondor University Hospital and Paris XII School of Medicine, Créteil, France

Address correspondence and reprint requests to Gilles Dhonneur, MD, 51 Avenue du Maréchal de Lattre-de-Tassigny, 94000 Créteil Cedex, France. Address email to gilles.dhonneur{at}hmn.ap-hop-paris.fr

Because of difficult weaning from mechanical ventilation, a 59-yr-old man admitted for emergency cardiac surgery underwent a bedside PercuTwist tracheostomy on day 14 of his intensive care unit stay. We observed a double fracture of the second tracheal ring during the initial dilation process with the PercuTwist dilator, associated with distal migration of a cartilage fragment, which was avulsed from the anterior portion of the second cartilaginous ring.

IMPLICATIONS: Like other antegrade single-step techniques, the PercuTwist tracheostomy presents the risk of anterior tracheal wall damage during the initial stage of the dilation process. Antegrade forces applied to the trachea should be minimized by sufficiently deep skin incision and both slow and smooth initial rotation of the dilator.