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. 2023 Jul 24;85(9):4547–4552. doi: 10.1097/MS9.0000000000000379

Successful removal of an aspirated broken metal tracheostomy tube from the right main bronchus: a case report

Mohammad Vakili Ojarood a, Ali Samady Khanghah b,*
PMCID: PMC10473327  PMID: 37663683

Abstract

Introduction and importance:

Tracheostomy has been done since ancient Greece, but in today’s modern format, it has been accepted for over one and a half centuries. Improvements in medical care and treatments have survived disabled patients who died in the past decades. Among these, tracheostomy tube (TT) segment aspiration was as rare as less than 100 cases have already been documented. We reported a case of aspirated metal TT to the right main bronchus from a 12-year-old teenage girl and then reviewed the available literature.

Case presentation:

The patient suffered from subglottic stenosis affected after adenotonsillectomy remained for 6 years. She was referred to the emergency department for acute respiratory distress and cyanosis. Immediately underwent rigid bronchoscopy, and on the way to the operating room, she was oxygenated from the tracheal orifice. The detached part was successfully removed.

Clinical discussion:

The common tracheostomy indications in children involve congenital or acquired airway stenosis, some conditions needing long-term ventilation, bilateral vocal fold insufficiency, and infectious compromise of the upper airway. Metal TTs for long-lasting are preferred to synthetic ones. Nevertheless, it has some potential complications.

Conclusion:

Careful inspecting, especially metallic TTs, after every disinfection and regular follow-up by the surgeon, is highly recommended to prevent potential casualties.

Keywords: aspiration, rigid bronchoscopy, subglottic stenosis, tracheostomy tube

Introduction

Highlights

  • Tracheostomy is one of the oldest known surgical procedures.

  • Advances in medical care in the new era have increased who needs breathing aid devices like a tracheostomy.

  • Tracheostomy tube segments aspiration is so rare that less than 100 cases have already been reported.

  • The patient and his/her medical care providers should be attentive to metallic tracheostomy tube maintenance.

Tracheostomy, a surgical opening of a way out of the trachea and inserting a tube, is one of the oldest known surgical procedures. Although not in today’s form, ancient Greek people did this procedure. However, since the mid-1800s, with the invention of Armand Trousseau, a French physician, routine tracheostomy procedures have spread worldwide1. In this era, developments in surviving premature neonates and the pediatric population suffering from congenital malformations have naturally increased tracheostomies. Even though life-saving, it usually accompanies by various complications. Fractures then getting stuck in a part of the tracheostomy tube (TT) in the tracheobronchial tree is a rare entity that has already been reported in less than 100 cases since 1960. For an airway emergency, it is necessary to manage the patient as soon as possible with an otorhinolaryngologist or a thoracic surgeon. Anyhow, dealing with any foreign body in the laryngotracheobronchial tree has remained challenging. Rigid bronchoscopy is typically the standard management for foreign body aspiration. Before the introduction of bronchoscopy, it had high mortality and morbidity. Although persisting, with the advent of bronchoscopy, this has reduced drastically2. We have reported a case of aspirated broken metal TT into the right main bronchus in a 12-year-old girl that was successfully removed by rigid bronchoscopy. Then, we reviewed all the available literature for the previous 61 years as much as possible. This work has been reported in line with the Surgical CAse REport (SCARE) criteria3.

Presentation of the case

A 12-year-old tracheostomized thin girl with acute onset dyspnea and stridor without cyanosis was presented to the emergency department. Her respiration was quick and deep, with a rate of 30 per minute and subcostal retractions. At the time of removal, cleaning, disinfecting and putting in place of the metal TT, a part was broken and aspirated. The respiratory symptoms were initiated in her 6th year of life when she for constant coughing, adenotonsillar hyperplasia with obstructive sleep apnea refers to bilateral tonsillectomy. During surgery for subglottic stenosis, the child underwent tracheostomy since several graded beguinage attempts had failed. It lasted for 18 days, but intolerance and respiratory problems occurred again. Numerous attempts to fix the stenosis had failed until the decision was made to have a permanent TT. The patient has had systemic sclerosis since her 6th year old too. She lived with her permanent metal TT, which was cleaned, disinfected, and put in place every day until the accident occurred. Her 7-year-old sister respires through a TT because of subglottic stenosis. The patient immediately underwent oxygenation through her orifice at the level of the trachea and was then transferred to the operating room. A portable anteroposterior X-ray revealed that the inner curve part of the TT had been stuck into the right main bronchus (Fig. 1). After deep sedation by rigid bronchoscopy through the tracheostomy, the thoracic surgeon successfully removed the broken segment from the right bronchus (Fig. 2). The balloon catheter technique was not used for three reasons: (1) for this, we needed bronchoscopy first to localize the foreign body while bronchoscopy has two diagnostic and therapeutic roles; (2) bronchoscopy is a more accessible modality; and (3) in the cases of bronchoscopic procedure failure, the balloon catheter technique find indication.

Figure 1.

Figure 1

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The digital portable anteroposterior chest X-ray revealing the metallic separated part with an approximate length of 63 mm.

Figure 2.

Figure 2

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The foreign body is perfectly removed.

The recovery and follow-up periods were uneventful.

Discussion

Tracheostomy operation is as common as more than 110 000 are done annually in the United States4. This procedure was known from the era of ancient Greece when Asclepiades first described it in 100 BC. Its use flourished in the mid-19th century by Armand Trousseau in treating diphtheria-associated dyspnea5. Although there is no diphtheria today, advances in medicine have survived many care-dependent patients who died in the past.

Common tracheostomy indications in children include airway stenosis, whether congenital or acquired, neurologic conditions requiring long-term ventilation or pulmonary toilet, bilateral vocal fold insufficiency, and infectious compromise of the upper airway6. In 40–50% of cases, complications occur. However, most tracheostomy-related complications are minor; 1% will suffer a catastrophic event, and of those, up to half will die7. Its complications are divided into three intraoperative, early, and late postoperative categories. Most intraoperative complications are hemorrhage, air embolism, and damage to the trachea. However, the most common postoperative complications in childhood are granuloma formation, infection, obstruction of the cannula, accidental decannulation, and post-decannulation trachea cutaneous fistula, respectively8. Nearly a quarter of tracheostomized patients will require hospital admission within a month of their tracheostomy placement9. More than 90% of severe tracheostomy complications occur more than 1 week after placement10.

Reviewing the literature entitled ‘tracheostomy complications’, we encountered the abovementioned complications. Aspiration of broken parts of TTs to the tracheobronchial tree as a complication was as rare as we were only able to collect and summarize 78 cases since 1960 (Table 1). However, many cases had not been declared the primary indication for tracheostomy; most were related to tracheolaryngeal stenosis due to prolonged intubation and ventilator dependency11–26.

Table 1.

A summary of the previous works already reported in the medical literature, classified by the authors’ names, year of publication, demographic information of the patients, the material used in tubes’ structures, the underlying disorder that necessitated tracheostomy, the initial signs and symptoms the patients had, the stuck place in the tracheobronchial tree, the place of fracture, and the final outcome of them.

Authors Year Age and sex Type of tube Indication Presentation Stuck place Site of fracture Outcome
1. Bassoe et al.33 1960 35 Silver/nickel Poliomyelitis ND ND Distal end of cannula ND
2. Kakar et al.34 1972 40 Copper/zinc Scleroma of laryngopharynx ND ND Neck plate ND
3. Kemper et al.49 1972 48/M Metal ND ND Trachea and right main bronchus Inner tracheostomy tube ND
4. Sood et al.50 1973 60 Plastic Laryngeal cancer Respiratory distress ND Neck plate ND
5. Maru et al.35 1978 50 Copper/zinc Bilateral vocal cord paralysis Respiratory distress ND Neck plate ND
6. Okafor et al.36 1983 40 Silver/zinc Neck trauma Respiratory distress ND Neck plate ND
7. Bhalla.51 1983 50/F ND ND ND Left main bronchus Outer tube ND
8. Otto R et al.37 1985 3/M Metal Bilateral vocal cord paralysis for Hyaline membrane disease Respiratory distress Right main stem bronchus Shaft Successful removal by rigid bronchoscopy
9. Bowdler et al.11 1985 3 Silver Subglottic stenosis ND ND Neck plate ND
10. Bowdler et al.11 1985 76 Silver Bilateral vocal cord paralysis ND ND Neck plate ND
11. Kohli et al.12 1987 40 Metal Bilateral vocal cord paralysis ND ND Neck plate ND
12. Kohli et al.12 1987 30 Polyvinyl chloride Laryngeal stenosis ND ND Unknown ND
13. Kohli et al.12 1987 55 Polyvinyl chloride Laryngeal cancer ND ND Unknown ND
14. Kohli et al.12 1987 65 Polyvinyl chloride Laryngopharyngeal cancer ND ND Unknown ND
15. Kohli et al.12 1987 68 Polyvinyl chloride Laryngeal cancer ND ND Unknown ND
16. Kohli et al.12 1987 69 Polyvinyl chloride Laryngopharyngeal cancer ND ND Unknown ND
17. Kohli et al.12 1987 32 Polyvinyl chloride Laryngeal trauma ND ND Unknown ND
18. Sullivan et al.13 1987 4 Silicone rubber Ventilator dependence Respiratory distress ND Neckplate ND
19. Majid et al.38 1989 63 Silver Bilateral vocal cord paralysis ND ND Neck plate ND
20. MING C. C. et al14 1989 50/M silver Jackson tracheostomy tube, size 28 Supraglottic and tracheal stenosis due to prolonged intubation post-pericardiectomy Discomfort over the right side of his chest after violent coughing Right main bronchus Stem Successful removal by rigid bronchoscopy
21. A. R. NICOLAIDES39 1990 73/M Silver Total laryngectomy 14 years previously Respiratory distress Right main bronchus Obturator Successful removal by rigid bronchoscopy
22. P. J. BROCKHURST40 1991 16m/F Silver Holinger tracheostomy tube ND ND ND ND Death of the infant
23. Bhatia et al.52 1992 58 Polyvinyl chloride ND Respiratory distress ND Neck plate ND
24. Bhatia et al.52 1992 63 Polyvinyl chloride ND None ND Neck plate ND
25. Bhatia et al.52 1992 68 Polyvinyl chloride Laryngopharyngeal cancer Respiratory distress ND Neck plate ND
26. AIJAZ ALVI et al.32 1994 47/M no. 8 fenestrated Shiley tracheostomy tube with a nonfunctional cuff. Morbidly obese and tracheotomized for obstructive sleep apnea A foul smell from the tracheostomy tube and a mass under his tube. Trachea Stem Successful removal
27. GUPTA S.C. et al.53 1996 10/M Fuller's biflanged metallic tracheostomy tube Laryngeal diphtheria. At the age of six, one flange of the outer tracheostomy tube fractured and lodged in the left main bronchus ND Right main bronchus Two parts of flanges Removal from right bronchus under general anesthesia. The older one was left in the distal part of left bronchus.
28. Nayak D. R. et al.41 1999 70/M Fuller's tracheostomy tube Stroke with left vocal cord paralysis Hemoptysis, fever, and chest pain Bilateral primary bronchi Two parts of flanges Success in the first and failure in the second time
29. Polycarp N. Gana et ali.54 1999 7/M Polyvinyl chloride Recurrent respiratory papillomatosis Mysterious disappearance’ of the shafts of the tracheostomy Right and left main bronchi Two parts in the shaft Successful removal by rigid bronchoscopy
30. Krempl et al.34 1999 48/M ND ND ND Trachea and right main bronchus Fenestra ND
31. V. K. Poorey.44 2000 28/M Fullers ND Sudden onset of cough Left main bronchus From the flange Successful removal by rigid bronchoscopy
32. Srirompotong et al.55 2001 7/M ND ND ND Left main bronchus Inner tracheostomy tube ND
33. Daniel K. Ng et al.15 2002 3/M Portex blue line tracheostomy tubes (Kent,UK) Spinal muscular atrophy type I. Sudden decrease in O2 saturation Left main bronchus Broken at the connection between the tube and the neck plate Successful removal by rigid bronchoscopy
34. José C Fraga et al.16 2003 6/F PVC tracheostomy tube (Portex ®) Central Alveolar Hypoventilation Syndrome idiopathic ND Distal trachea At the junction with the horizontal plate Successful removal by rigid bronchoscopy
35. A. M. Shivakumar et al.31 2003 20/M Fuller's tube Bilateral abductor paralysis of the vocal cords Mild respiratory distress Above the carina Inner tube Jackson's tracheostomy tube was inserted.
36. Iwao Takanami et al.17 2007 70/M silicone T-tube Respiratory failure due to Pancreaticoduodenectomy for an intraductal papillary neoplasm of the pancreas and a rectal carcinoma Vomiting a piece of the broken T-tube and coughing ND At the junction of the proximal portion of the vertical and horizontal limbs Successful removal by rigid bronchoscopy
37. Wu et al.56 2007 14m/F PVC ND ND Trachea and left main bronchus ND ND
38. S Shashinder et al.57 2008 Three cases Synthetic, non-metallic type ND Alarm on the ventilator indicating a hypoxic event ND Fractured from the neck plate of the tube Successful removal by rigid bronchoscopy
39. Radpay et al.43 2009 41/M Metal ND ND Trachea and left main bronchus Shaft ND
40. Patorn Piromchai et al.18 2010 14 No. 5 stainless steel tracheostomy tube Prolonged intubation after a burr-hole craniotomy for subdural hematoma evacuation Cough with hyperpnea Right main bronchus At the junction between the inner tube and connector Successful removal by rigid bronchoscopy
41. Irfan Iqbal et al.19 2011 10/F Metallic tracheostomy tube Sub-glottic stenosis noticing that her tube was not present at the tracheostomy site without distress Left main bronchus Detachment from the flanges of tracheostomy tube Successful removal by rigid bronchoscopy
42. Arvind Krishnamurthy et al.44 2011 60/M Metallic Total laryngectomy with adjuvant radiotherapy for carcinoma larynx Occasional cough with labored breathing Lodged partly in the trachea and partly along the left main bronchus A fracture at the junction between the inner tube and neck plate. Successful removal by rigid bronchoscopy
43. Zareen Aliiana Lynrah et al.20 2012 7/M Angeltouch PVC uncuffed tube Meningitis and prolonged intubation Severe cough, severe tachypnoea and tachycardia Right main bronchus From the flange at the junction Successful removal, aspiration pneumonia then recovery
44. Zareen Aliiana Lynrah et al.20 2012 8/F Number 6 mm ID Angeltouch1 tracheostomy tube ND Sudden severe stridor, severely desaturating (SpO2 < 25%) ND ND Succumbed to death
45. Zareen Aliiana Lynrah et al.20 2012 5 Number 4 mm ID Angeltouch1 PVC tracheostomy ND Severe pain and respiratory distress with severe cyanosis ND Endotracheal part had been separated from the flange Successful removal and Montgomery T-tube placement.
46. Pradipta Kumar Parida26 2014 1/M Romson tube (PVC) Retropharyngeal abscess with bilateral abductor VC paralysis ND Trachea just below the stoma Junction between tube and neck plate Local wound exploration and removal under direct vision
47. Pradipta Kumar Parida26 2014 6/F Jackson tube, copper, zinc, nickel Subglottic stenosis secondary to prolonged intubation ND Trachea and left main bronchus Junction between inner tube and neck plate Successful removal by rigid bronchoscopy
48. Pradipta Kumar Parida26 2014 7/F Romson tube (PVC) Subglottic stenosis secondary to prolonged intubation ND Right main bronchus Junction between tube and neck plate Successful removal by rigid bronchoscopy
49. Pradipta Kumar Parida26 2014 8/M Jackson tube, copper, zinc, nickel Congenital subglottic hemangioma ND Right main bronchus Junction between inner tube and neck plate Successful removal by rigid bronchoscopy
50. Pradipta Kumar Parida26 2014 9/M Jackson tube, copper, zinc, nickel Bilateral abductor palsy ND Right main bronchus Junction between tube and neck plate Successful removal by rigid bronchoscopy
51. Pradipta Kumar Parida26 2014 11/ F Romson tube (PVC) Bilateral abductor paralysis ND Trachea below the stoma Junction between tube and neck plate Successful removal by rigid bronchoscopy
52. Pradipta Kumar Parida26 2014 13/F Jackson tube, copper, zinc, nickel Bilateral abductor paralysis ND Right main bronchus Junction between inner tube and neck plate Successful removal by rigid bronchoscopy
53. Pradipta Kumar Parida26 2014 15/F Fuller tube, copper and Zinc Post OP poisoning besides subglottic stenosis ND Right main bronchus Junction between tube And the flange Successful removal by rigid bronchoscopy
54. Hashem M. Al-Momani et al.23 2015 4/F ND Recurrent pneumonia and prolonged intubation for Leigh’s disease, developmental delay, hypotonia, and delayed walking Coughing, cyanosis and oxygen desaturation Left main bronchus From its base Successful removal by rigid bronchoscopy
55. Dra. Giselle Cuestas et al.45 2015 18m Metal Craniofacial malformation due to Apert syndrome Cardiorespiratory arrest Trachea and right main bronchus Junction of the neck plate with the tubular Successful removal by rigid bronchoscopy
56. Apichart So-ngern et al.46 2016 65/M Metal Bed-bound from hemorrhagic stroke Fever and cough with purulent sputum Left main bronchus From its proximal part Successful removal by rigid bronchoscopy
57. Suman Lata Gupta et al.22 2016 6/M 3.5 Portex tracheostomy tube Subglottic stenosis due to prolonged intubation for lung abscess, and thoracic vertebral TB Cyanosis and seizure, SPO2=45%, Right main bronchus From its base Successful removal by rigid bronchoscopy
58. Seyed Mozafar Hashemi et al.58 2017 57/M PVC Laryngeal cancer from 15 years previously Respiratory distress Carina From its base Successful removal by fiberoptic bronchoscopy
59. Ambasta S et al.24 2018 48/M 32 size Fuller’s tube Tracheal stenosis due to difficult intubation. Breathing difficulty Right main bronchus At the junction of flanges and the collar of the tube Successful removal by rigid bronchoscopy
60. Kashoob M et al.47 2018 29/M Jackson’s metallic double-lumen tube Leukodystrophy and kyphosis High grade fever, respiratory distress, and an altered level of consciousness Right main bronchus Flange Successful removal by rigid bronchoscopy
61. Vaishnavi BD et al.25 2019 50/M 6.5-mm cuffed tube Prolonged mechanical ventilation due to failure to wean Dyspnea, Trachea At the junction of flange Successful removal by rigid bronchoscopy
62. Li-Jun Bo et al.48 2019 77 Metal Surgical repair of broken ribs Cough and bleeding at the tracheostomy site Left main bronchus End of the metal tracheostomy tube Surgical removal by rigid bronchoscopy
63. Pradipta-Kumar Parida et al.21 2020 1/ M Romson’s tube (PVC) Retropharyngeal abscess with bilateral abductor VC paralysis ND Trachea just below the stoma Junction between inner tube and neck plate Surgical removal by rigid bronchoscopy
64. Pradipta-Kumar Parida et al.21 2020 6/F Jackson’s tube (copper, zinc, nickel) Subglottic stenosis secondary to prolonged intubation ND Trachea and Left main bronchus Junction between inner tube and neck plate Surgical removal by rigid bronchoscopy
65. Pradipta-Kumar Parida et al.21 2020 7/F Romson’s tube (PVC) Subglottic stenosis secondary to prolonged intubation ND Right main bronchus Junction between inner tube and neck plate Surgical removal by rigid bronchoscopy
66. Pradipta-Kumar Parida et al.21 2020 8/M Jackson’s tube (copper, zinc, nickel) Congenital subglottic hemangioma ND Right main bronchus Junction between inner tube and neck plate Surgical removal by rigid bronchoscopy
67. Pradipta-Kumar Parida et al.21 2020 9/M Jackson’s tube (copper, zinc, nickel) Bilateral abductor palsy ND Right main bronchus Junction between inner tube and neck plate Surgical removal by rigid bronchoscopy
68. Pradipta-Kumar Parida et al.21 2020 11/F Romson’s tube (PVC) Bilateral abductor paralysis ND Trachea below the stoma Junction between inner tube and neck plate Surgical removal by rigid bronchoscopy
69. Pradipta-Kumar Parida et al.21 2020 13/F Jackson’s tube (copper, zinc, nickel) Bilateral abductor paralysis ND Right main bronchus Junction between inner tube and neck plate Surgical removal by rigid bronchoscopy
70. Pradipta-Kumar Parida et al.21 2020 15/F Fuller’s tube (copper and Zinc) Post OP poisoning with subglottic stenosis ND Right main bronchus Junction between Inner tube and neck plate Surgical removal by rigid bronchoscopy
71. Pradipta-Kumar Parida et al.21 2020 6/M Romson’s tube (PVC) Subglottic stenosis secondary to prolonged intubation for retropharngeal abscess ND Trachea below the stoma Junction between inner tube and neck plate Surgical removal by rigid bronchoscopy
72. Pradipta-Kumar Parida et al.21 2020 14/M Jackson’s tube (copper, zinc, nickel) Prolonged intubation for meningoencephalitis ND Carina Junction between inner tube and neck plate Surgical removal by rigid bronchoscopy
73. Pradipta-Kumar Parida et al.21 2020 12/F Fuller’s tube (copper and Zinc) Bilateral abductor palsy ND Right main bronchus Just distal to the junction of two flanges ND
74. Bharat Hosur59. 2020 35/M ND ND Dyspnea Carina and the Left main bronchus From the proximal part Successful removal
75. Our case 2021 12/F Metal Subglottic stenosis Respiratory distress Right main bronchus Neck plate Successful removal
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Since the metal tubes are rigid and have a lower risk of getting fractured, they are more favored for prolonged use. Factors predisposing such tubes to be broken: (1) wear and tear for a long time causing ageing or reinsertion of a tube, (2) frequent sterilizing through boiling, using sodium bicarbonate, or sodium hypochlorite solutions, (3) tissue reactions and granulation formation between the fangs of the Fuller’s tube leading to loosening and constant continued pressure, (4), follow-up deficiency, and alkaline pH of respiratory secretions and moisture which by stagnating over the tube and chemical reaction with zinc and copper elements, leads to erosions over the tube. This process is called season cracking27–31. Typically, the evidence mentioned above has been derived from studies on the pediatric population. Outer flangs are the most disposed of part to be broken31. The most vulnerable tubes to be fracture are alloys of copper, zinc, nickel, or silver. These metallic elements have poor corrosion resistance32. Among the summarized cases above, we found 39 out of 77 accident reports with specifically metallic TTs11,12,14,18,19,21,22,24,26,31,33–48.

Conclusion

The best way to prevent complications and accidents related to a metal tracheal tube is first to instruct the patient and his or her family on proper home tube cleaning and then adequately warn them regarding the importance of follow-up. However, the surgeon knows when the time for the tube replacement is. The tube and neck plate junction is the most vulnerable fracture site in metal TTs. We also need to be more aware of aspirated broken metal TTs from the right main bronchus and that more studies are needed to understand the advantages and limitations.

Ethical approval

This issue has been raised and approved by the ethics committee of Ardabil University of Medical Sciences, Iran.

Consent

The consent in which the patient has allowed to use medical records and therapeutic information is attached to the medical document. The authors testify the patient privacy maintenance. On request, a copy of the written consent is available for review by the Editor-in-Chief of this Journal. The authors ensure that all the images/figures/photos are suitably anonymized with no patient information or means of identifying the patient.

Sources of funding

This research received no specific grant from public, commercial, or not-for-profit funding agencies.

Author contribution

M.V.O.: the thoracic surgeon who has visited the patient and taken conservative management, also proposed manuscript writing and the role of supervision; A.S.K.: a member of the research committee of the hospital, prepared the manuscript, decided to advance it to a ‘case report and literature review’ manuscript, and then pursues the submission process.

Conflicts of interest disclosure

The authors declare that there are no conflicts of interest.

Research registration unique identifying number (UIN)

Since this case report does not contain any new surgical technique or equipment, it has no Research Registry UIN.

Guarantor

Ali Samady Khanghah accepts full responsibility for the work and approves the whole process, from designing the study to publishing.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Footnotes

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 24 July 2023

Contributor Information

Mohammad Vakili Ojarood, Email: mohammad.vakili@arums.ac.ir.

Ali Samady Khanghah, Email: alisamady89@yahoo.com.

References

  • 1. Feldmann H. Treatment of acute and chronic laryngeal and tracheal stenoses in the 19th and beginning of the 20th century by tracheotomy, coniotomy, intubation and dilatation. Pictures from the history of otorhinolaryngology illustrated by instruments from the collection of the Ingolstadt Medical History Museum. Laryngo-Rhino-Otologie 1995;74:216–222. [DOI] [PubMed] [Google Scholar]
  • 2. Sumanth TJ, Bokare BD, Mahore DM, et al. Management of tracheobronchial foreign bodies: a retrospective and prospective study. Indian J Otolaryngol Head Neck Surg 2014;66:60–64. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Agha RA, Franchi T, Sohrabi C, et al. The SCARE 2020 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg 2020;84:226–230. [DOI] [PubMed] [Google Scholar]
  • 4. Shah RK, Lander L, Berry JG, et al. Tracheotomy outcomes and complications: a national perspective. Laryngoscope 2012;122:25–29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5. Wood D, McShane P, Davis P. Tracheostomy in children admitted to paediatric intensive care. Arch Dis Child 2012;97:866–869. [DOI] [PubMed] [Google Scholar]
  • 6. Mahadevan M, Barber C, Salkeld L, et al. Pediatric tracheotomy: 17 year review. Int J Pediatr Otorhinolaryngol 2007;71:1829–1835. [DOI] [PubMed] [Google Scholar]
  • 7. Bontempo LJ, Manning SL. Tracheostomy emergencies. Emerg Med Clin North Am 2019;37:109–119. [DOI] [PubMed] [Google Scholar]
  • 8. Dal'astra AP, Quirino AV, Caixêta JA, et al. Tracheostomy in childhood: review of the literature on complications and mortality over the last three decades☆. Braz J Otorhinolaryngol 2017;83:207–214. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9. Weiss AJ Elixhauser A, and Steiner C, Statistical Brief #154: Readmissions to US Hospitals by Procedure, 2010. Agency for Healthcare Research and Quality (US); 2013. [PubMed]
  • 10. Das P, Zhu H, Shah RK, et al. Tracheotomy‐related catastrophic events: results of a national survey.. Laryngoscope 2012;122:30–37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Bowdler DA, Emery PJ. Tracheostomy tube fatigue: an unusual cause of inhaled foreign body. J Laryngol Otol 1985;99:517–521. [PubMed] [Google Scholar]
  • 12. Kohli GS, Yadav SP, Sharma RC, et al. Tracheostomy tubes – presenting as foreign bodies in tracheobronchial tree. Indian J Chest Dis Allied Sci 1987;29:13–6. [PubMed] [Google Scholar]
  • 13. Sullivan MJ, Hom DB, Passamani PP, et al. An unusual complication of tracheostomy. Arch Otolaryngol Head Neck Surg 1987;113:198–199. [DOI] [PubMed] [Google Scholar]
  • 14. Ming C, Ghani S. Fractured tracheostomy tube in the tracheobronchial tree. J Laryngol Otol 1989;103:335–336. [DOI] [PubMed] [Google Scholar]
  • 15. Ng DK, Cherk SW, Law AK. Flexible fiberoptic bronchoscopic removal of a fractured synthetic tracheostomy tube in a 3‐year‐old child. Pediatr Pulmonol 2002;34:141–143. [DOI] [PubMed] [Google Scholar]
  • 16. Fraga JC, Souza JCK, Kruel J. Pediatric tracheostomy. J Pediatr 2009;85:97–103. [DOI] [PubMed] [Google Scholar]
  • 17. Takanami I, Abiko T, Kurihara H. Fracture of silicone tracheal T-tube: a rare complication. J Thorac Cardiovasc Surg 2007;134:1362–1363. [DOI] [PubMed] [Google Scholar]
  • 18. Piromchai P, Lertchanaruengrit P, Vatanasapt P, et al. Fractured metallic tracheostomy tube in a child: a case report and review of the literature. J Med Case Rep 2010;4:1–4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Iqbal I, Lateef M, Wani AA, et al. A rare case of foreign body bronchus: a case report. Indian J Otolaryngol Head Neck Surg 2011;63:81–82. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20. Lynrah ZA, Goyal S, Goyal A, et al. Fractured tracheostomy tube as foreign body bronchus: our experience with three cases. Int J Pediatr Otorhinolaryngol 2012;76:1691–1695. [DOI] [PubMed] [Google Scholar]
  • 21. Parida P-K, Kalaiarasi R, Alexander A, et al. Factors associated with fracture and migration of tracheostomy tube into trachea in children: a case series. Iran J Otorhinolaryngol 2020;32:379. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22. Gupta SL, Swaminathan S, Ramya R, et al. Fractured tracheostomy tube presenting as a foreign body in a paediatric patient. BMJ Case Rep 2016;2016:bcr2015213963. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. Al-Momani HM, Alzaben KR, Mismar A. Upper airway obstruction by a fragmented tracheostomy tube: case report and review of the literature. Int J Surg Case Rep 2015;17:146–147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. Ambasta S, Gupta S, Rajiv G, et al. Fractured tracheostomy tube posted for bronchoscopic removal: an anesthetic challenge. Saudi J Anaesth 2018;12:142. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Vaishnavi B, Kothari N. Use of pilot balloon to fish out fractured tracheostomy tube: a case report. A A Pract 2020;14:58–59. [DOI] [PubMed] [Google Scholar]
  • 26. Parida PK, Kalaiarasi R, Gopalakrishnan S, et al. Fractured and migrated tracheostomy tube in the tracheobronchial tree. Int J Pediatr Otorhinolaryngol 2014;78:1472–1475. [DOI] [PubMed] [Google Scholar]
  • 27. Goldenberg D, Ari EG, Golz A, et al. Tracheotomy complications: a retrospective study of 1130 cases. Otolaryngol Head Neck Surg 2000;123:495–500. [DOI] [PubMed] [Google Scholar]
  • 28. Graham RJ, Rodday AM, Parsons SK. Family-centered assessment and function for children with chronic mechanical respiratory support. J Pediatr Health Care 2014;28:295–304. [DOI] [PubMed] [Google Scholar]
  • 29. Glass KC, Carnevale FA. Decisional challenges for children requiring assisted ventilation at home. HEC Forum 2006;18:207–21. [DOI] [PubMed] [Google Scholar]
  • 30. Lindahl B, Lindblad B-M. Family members’ experiences of everyday life when a child is dependent on a ventilator: a metasynthesis study. J Fam Nurs 2011;17:241–269. [DOI] [PubMed] [Google Scholar]
  • 31. Shivakumar AM, Naik AS, Prashanth KB, et al. Unusual foreign body in the trachea. Indian J Otolaryngol Head Neck Surg 2003;55:268–269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32. Alvi A, Zahtz GD. Fracture of a synthetic fenestrated tracheostomy tube: case report and review of the literature. Am J Otolaryngol 1994;15:63–67. [DOI] [PubMed] [Google Scholar]
  • 33. Bassoe HH, Boe J. Broken tracheotomy tube as a foreign body. Lancet 1960;1:1006–1007. [DOI] [PubMed] [Google Scholar]
  • 34. Kakar PK, Saharia PS. An unusual foreign body in the tracheobronchial tree. J Laryngol Otol 1972;86:1155–1157. [DOI] [PubMed] [Google Scholar]
  • 35. Maru YK, Puri ND, Majid A. An unusual foreign body in the tracheobronchial tree. J Laryngol Otol 1978;92:1045–1048. [DOI] [PubMed] [Google Scholar]
  • 36. Okafor BC. Fracture of tracheostomy tubes: pathogenesis and prevention. J Laryngol Otol 1983;97:771–774. [DOI] [PubMed] [Google Scholar]
  • 37. Otto RA, Davis W. Tracheostomy tube fracture: an unusual etiology of upper respiratory airway obstruction. Laryngoscope 1985;95:980–981. [DOI] [PubMed] [Google Scholar]
  • 38. Majid AA. Fractured silver tracheostomy tube: a case report and literature review. Singapore Med J 1989;30:602–604. [PubMed] [Google Scholar]
  • 39. Nicolaides AR. Silver tracheostomy tube obturator in the tracheobroncial tree. J Laryngol Otol 1990;104:437. [DOI] [PubMed] [Google Scholar]
  • 40. Brockhurst P, Feltoe C. Corrosion and fracture of a silver tracheostomy tube. J Laryngol Otol 1991;105:48–49. [DOI] [PubMed] [Google Scholar]
  • 41. Nayak DR, Gopal A, Sharma S. An unusual foreign body in the tracheobronchial tree. Indian J Otolaryngol Head Neck Surg 1999;52:97–98. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42. Poorey VK, Iyer A. Unusual foreign body (broken tracheostomy tube) in left main bronchus. Indian J Otolaryngol Head Neck Surg 2001;53:233–234. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43. Radpay B, Pejhan S, Dabir S, et al. Fracture and aspiration of tracheostomy tube. TANAFFOS (Respiration) 2009;8(1(Winter)):75–78. [Google Scholar]
  • 44. Krishnamurthy A, Vijayalakshmi R. Broken tracheostomy tube: a fractured mandate. J Emerg Trauma Shock 2012;5:97. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45. Cuestas G, Martínez JC, Pena R, et al. Fractured tracheostomy tube: a rare cause of respiratory distress in the tracheotomised child. Case report. Arch Argent Pediatr 2015;113:e353–e356. [DOI] [PubMed] [Google Scholar]
  • 46. So-Ngern A, Boonsarngsuk V. Fractured metallic tracheostomy tube: a rare complication of tracheostomy. Respir Med Case Rep 2016;19:46–48. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47. Kashoob M, Al Washahi M, Tandon R. Aspiration pneumonia due to migration of fracture tracheostomy tube after 14 years of use. Oman Med J 2020;35:e113. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 48. Bo L-J, Yu PX, Qi X, et al. Anesthetic management of a patient with an unusual broken tracheostomy tube: a case report. J Int Med Res 2019;47:718–721. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49. Kemper BI, Rosica N, Myers EN, et al. Inner migration of the inner cannula: an unusual foreign body. Eye Ear Nose Throat Mon 1972;51:257–8. [PubMed] [Google Scholar]
  • 50. Sood RK. Fractured tracheostomy tube. J Laryngol Otol 1973;87:1033–4. [DOI] [PubMed] [Google Scholar]
  • 51. Bhalla K, Bais A, Mahindra S. An unusual bronchial foreign body. Indian Journal of Otolaryngology 1983;35:66–7. [Google Scholar]
  • 52. Bhatia S, Malik MK, Bhatia BP. Fracture of tracheostomy tubes--report of 3 cases. Indian J Chest Dis Allied Sci 1992;34:111–3. [PubMed] [Google Scholar]
  • 53. Gupta SC, Ahluwalia H. Fractured tracheostomy tube: an overlooked foreign body. J Laryngol Otol 1996;110:1069–71. [DOI] [PubMed] [Google Scholar]
  • 54. Gana PN, Takwoingi YM. Fractured tracheostomy tubes in the tracheobronchial tree of a child. International journal of pediatric otorhinolaryngology 2000;53:45–8. [DOI] [PubMed] [Google Scholar]
  • 55. Srirompotong S, Yimtae K. Dislodge of T-tube into the bronchus, an unusual complication of the Montgomery T-tube: a case report. J Med Assoc Thai 2001;84:1772–4. [PubMed] [Google Scholar]
  • 56. Wu C-T, Lin J-J, Yeh R. Migration of fragmented tracheostomy tube into left main bronchus. International Journal of Pediatric Otorhinolaryngology Extra 2007;2:58–60. [Google Scholar]
  • 57. Shashinder S, Tang I, Kuljit S, et al. Fracture synthetic tracheostomy tube: an ENT emergency. Med J Malaysia 2008;63:254–5. [PubMed] [Google Scholar]
  • 58. Hashemi SM, Kolahdouzan M, Shahabi S, et al. Foreign Body Aspiration in Adults (Two Unusual Foreign Bodies; Knife and Tube Tracheostomy). Iran J Otorhinolaryngol 2017;29:59–61. [PMC free article] [PubMed] [Google Scholar]
  • 59. Hosur B, Ahuja CK, Virk RS, et al. Unusually dislodged tracheostomy tube with intact airway. BMJ Case Reports 2020;13. [DOI] [PMC free article] [PubMed] [Google Scholar]

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