Fracture and migration of a metallic tracheostomy tube: anesthetic considerations and case review.

BACKGROUND

Tracheostomy is commonly performed to maintain airway patency or to provide prolonged ventilatory support in elective and emergency settings. Although it offers substantial benefits, tracheostomy may be associated with early and late complications. Fracture and migration of a tracheostomy tube is exceptionally rare, with an incidence of less than 1 in 1000 cases. Such events can lead to life-threatening airway obstruction and present significant anesthetic and airway management challenges during retrieval.

CASE PRESENTATION: We report a 27-year-old male (weight 50 kg, height 172 cm, BMI 16.9 kg/m2) who had tracheostomy tube placed 18 years ago for prolonged ventilation after a road traffic accident. He had used the same metallic tube without replacement or follow-up. He presented with mild cough, blood-tinged sputum, and chest tightness. Imaging revealed a metallic foreign body in the right main bronchus. Emergency rigid bronchoscopy under general anesthesia allowed successful retrieval of the fractured outer tube through the tracheostomy stoma. Recovery was uneventful.

CONCLUSIONS

Fracture and migration of metallic tracheostomy tubes are rare but potentially life-threatening. Regular follow-up and timely tube replacement are vital for prevention. Effective management requires coordinated teamwork, careful anesthetic planning, and flexibility in ventilation strategies to ensure safety and good outcomes.