Failure of both suction catheter passage and bronchoscopy to diagnose an obstructing tracheal mucus plug

摘要

The patient's spouse gave informed consent for publication of this report. A 55-yr-old male sustained burns ina welding accident extending caudad from shoulder level over 65% of his body surface area. In the intervening two months, he required multiple surgeries, including debride-ment and skin grafting, a laparotomy for abdominal compartment syndrome, and a tracheostomy. Presenting on this occasion for further skin grafting, he was breathing easily and spontaneously through a size 8 fenestrated Shiley? tracheostomy cannula (Covidien, Mansfield, MA, USA) capped with a decannulation plug. In the operating room, the fenestrated inner cannula was exchanged for a non-fenestrated tube. Shortly after this change, the patient indicated some dyspnea. A suction catheter was introduced and moderate amounts of sputum were obtained, after which the patient signalled at least partial relief. Following application of routine monitors, anesthesia was induced using sevoflurane in oxygen through a circle system connected to the tracheostomy tube, supplemented with midazolam 2 mg and propofol 30 mg iv.