Intraoperative Ventilation Failure Due to a Fenestrated Tracheostomy Tube in a Three-Month-Old Infant with a Laryngeal Mass: A Case Report and Literature Review.

Pediatric tracheostomy is a common procedure, with a substantial proportion of cases performed on infants, often due to chronic respiratory failure or complex airway anomalies. This case report details a critical intraoperative event involving a three-month-old infant undergoing tracheostomy for a laryngeal mass. The patient experienced immediate and profound ventilation failure following the insertion of a fenestrated tracheostomy tube. Mechanical obstruction was ruled out by passing a suction catheter through the tube. Furthermore, switching ventilatory modes to pressure-controlled volume-guaranteed (PC-VG) or volume-controlled ventilation (VCV) was also ineffective in restoring adequate ventilation. This was managed using a completely unfenestrated tube. The tube was placed and the breathing circuit connected, a large portion of the air leak was successfully eliminated, and appropriate ventilation parameters were restored. Fenestrated tracheostomy tubes have established benefits in adults; however, this case highlights a cautionary observation in ventilated infants due to potential air leak and ventilatory failure, underscoring careful tube selection.