Unperceived bronchial bleeding complications during percutaneous dilatational tracheotomy: a case report and 3D simulation.

Percutaneous dilatational tracheostomy is an established technique for securing the airway in critically ill patients. One of the most common complications is bleeding around the incision or after injury to major vessels in anatomic proximity.We report a case in which a thrombocytopenic patient experienced life-threatening bleeding during the procedure at the bifurcation between segmental bronchus 9 and 10, apparently caused by an unrecognized guide wire-induced mucosal lesion. Immediate extensive bronchoscopy and hemostatic interventions were required to ensure oxygenation. To better illustrate this complication, a patient-specific (1:1) three-dimensional model of the patient's bronchial system was subsequently created using a 3D printer. In conclusion, 3d printing can help to visualize uncommon complications during intensive care interventions. It is recommended to advance the guide wire the guide wire only until the tracheal carina under bronchoscopic control.Word count: 135.