A Successful Percutaneous Dilatational Tracheostomy Procedure in Pneumonectomized Patient: A Case Report

Tuberculosis (TB) continues to be a substantial cause of morbidity and the current approach to TB treatment is medical chemotherapy. However the most common benign cause of pneumonectomy is still pulmonary tuberculosis and after pneumonectomy mediastinal structures could be displaced resulting airway obstruction. The tracheostomy procedure is recommended for ventilator dependent patients Percutaneous dilatational tracheostomy (PDT) mostly replaced surgical one due to its simplicity and cost effectiveness. In this case report, the authors describe a successful percutaneous dilatational tracheostomy procedure in a pneumonectomized patient. Keywords: Percutaneous Dilatational Tracheostomy; Pneumonectomy; Tuberculosis The tracheostomy procedure is recommended for patients who resumed to be mechanical ventilator dependent for a long time. Mainly two types of tracheostomy are used in the Intensive Care Unit (ICU) practice; Open surgical tracheostomy (OST) and Percutaneous dilatational tracheostomy (PDT) [3]. PDT mostly replaced OST due to its simplicity and cost effectiveness. OST usage gained popularity in the ICU during the polio epidemic in the 1950's and PDT was the modified version of one stage dilatation technique as described by Griggs et al. in 1990 [3,4]. The technique is to hole the trachea and insert a guide wire into it. This was done blindly until 1990 when Marelli et al. used bronchoscopy as an auxiliary to PDT to increase the safety of the procedure. In this case report, the authors describe a successful percutaneous dilatational tracheostomy procedure in a pneumonectomized patient which is rare in the literature due to its indication [5].Case report A 60-year-old,74-kg,166-cm male who had undergone right pneumonectomy 20 years ago for pulmonary TB was admitted to the coronary intensive care unit for pericardial effusion and pneumonia. He was found ( -) for TB screening tests (the patient's sputum smear results are negative for acid-fast bacilli). The pericardial effusion problem was solved via anterior subxiphoidal Case Report: A 60-year-old male who had undergone right pneumonectomy 20 years ago, could not be weaned from mechanical ventilation for a long period and percutaneous dilatational tracheostomy (PDT) procedure was performed successfully. He was weaned from the tracheostomy after 20 days and was discharged after 4 weeks. Discussion: Surgery is increasingly used in the era of “multi-drug resistant” tuberculosis and pneumonectomy causes displacement of respiratory anatomical structures.The most common cause of the tracheostomy requirement in the ICU is prolonged ventilatory support and in recent years we have seen extensive use of PDT almost supersedes surgical tracheostomy. The choice is often determined by subjective factors, experience, economic issues, and availability. In our case, with the aid of bronchoscopic guidance, PDT was done without any complication but one should not ignore relative contraindications of PDT.