Demet COŞKUN, Ahmet MAHLI, Senem TÜFEKÇİOĞLU

Subcutaneous emphysema due to pneumothorax following tracheotomy

Yaşamı tehdit eden obstrüktif üst solunum yolu enfeksiyonlarındaki azalma ve yoğun bakım tedavisindeki gelişmeyle çocuklardaki trakeotomi uygulamaları oldukça fazla değişikliğe uğramıştır. Trakeotomiden sonra gelişen pnömotoraks insidansı, yaş grubuna bağlı yapılan çalışmalarda % 0 - % 17 arasında rapor edilmiştir. Olgu: 2,5 yaşında, erkek çocuk hasta, solunum sıkıntısı nedeniyle farklı zamanlarda 2 kez trakeotomi yapılıp, solunumu rahatlayınca dekanüle edilerek bir hafta sonra taburcu edilmiştir. Hasta daha sonra solunum sıkıntısı nedeniyle hastanemize başvurdu. Subglotik stenoz tanısı konulan hasta hastaneye kubul edildi ve trakeotomi açılıp, kanül yerleştirildikten sonra servise yollandı. Ertesi gün sabaha karşı solunum sıkıntısı olan hastada; takipne, taşikardi ve dudaklarda siyanoz ile birlikte boyun, göğüs ve karın bölgesinde yaygın derialtı amfizemi gözlendi. Kanülün değiştirilmesi, %100 O2 ile ventile edilmesi, steroid ve teofilin verilmesine rağmen SpO2 değeri %72’nin üzerine yükselmedi. Dinlemekle akciğer sesleri sol tarafta sağa göre çok zayıftı. Bunun üzerine pnömotoraks olduğu düşünülerek, 16 G intraket ile midklavikular hat üzerinde 2. interkostal aralıktan interplevral boşluğa girilerek yaklaşık 30 cc hava aspire edildi. Bundan 1 dakika sonra, SpO2 değeri yavaş yavaş %96’ ya kadar yükseldi. Sonuç: Anestezi altında ya da uyanık hastada pnömotoraks olduğu düşünüldüğünde, semptomlar ve fizik muayene bulguları gözönünde bulundurularak tanı hemen konulmalı ve midklavikular hat üzerinde 2. interkostal aralıktan gecikmeksizin hava aspire edilmelidir

Trakeotomiden sonra gelişen pnömotoraksa bağlı derialtı amfizemi

and the ongoing improvement in intensive care medicine, the role of tracheotomy in children has changed considerably. The incidence of pneumothorax following tracheotomy is reported to be 0% to 17%, depending on the age group studied. Case: A 2.5-year-old boy had undergone two tracheotomies at different times due to respiratory difficulties, and when his respiration improved he was decannulated, and one week later discharged from the hospital. The patient was admitted to our hospital with respiratory difficulties, and the diagnosis was established as subglottic stenosis. Therefore, a tracheotomy was performed. Early the next morning, the patient had respiratory difficulty and then tachypnea, tachycardia, cyanosis of the lips, and widespread subcutaneous emphysema in the cervical, thoracal, and abdominal areas were observed. Although the cannula was replaced, ventilation with 100% O2 was performed, and steroid and theophylline were administered, SpO2 value did not rise above 72%. The pulmonary sounds were weaker on the left side than on the right, which suggested pneumothorax. Upon this finding, the intrapleural space was penetrated with a 16 G catheter on the left midclavicular line through the 2nd intercostal space, and approximately 30 cc of air was aspirated. One minute after this intervention, SpO2 value gradually rose as high as 96%. Conclusion: When pneumothorax is suspected in a patient under anesthesia or awake, the diagnosis should be established immediately by taking the symptoms and physical examination findings into consideration and air should be aspirated without delay through the 2nd intercostal space on the midclavicular line.

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