CEREBRAL AIR EMBOLISM DUE TO SUBCUTANEOUS EMPHYSEMA FROM TRACHEOSTOMY TUBE DISLODGEMENT

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: We present a case of tracheostomy tube dislodgement during mechanical ventilation leading to subcutaneous emphysema and cerebral air embolism. CASE PRESENTATION: A 33-year-old male with chronic on trach collar was hospitalized from skilled nursing facility for delirium. Past history notable rupture right-sided ophthalmic artery aneurysm status post endovascular clipping complicated by recurrent requiring hemicraniectomy persistent bony craniectomy defect. Long-term required pulmonary toilet as well bypass an area tracheal stenosis. Upon presentation the emergency department, he placed via his after which developed significant pneumomediastinum. He sustained PEA arrest return spontaneous circulation. Bilateral chest tubes were placed. CT scan head demonstrated marked pneumocephalus intracerebral emboli in Circle Willis, internal carotid arteries intracranial veins. Air tissue appears have tracked intracranially into cerebrovascular system right fronto-temporal skull bone subsequently epilepticus, ventilator-dependent respiratory failure remained comatose state. Cerebral imaging anoxic brain injury. transitioned comfort care. DISCUSSION: There been several reports following procedures including ventilation, bronchoscopy, dilation. Tracheostomy placement causing pneumothoraces, emphysema, pneumomediastinum, also previously described. arterial circulation can lead ischemic change end-organ damage particularly cardiac nervous systems, are most vulnerable microvascular occlusion. Even 2 milliliters may severe neurological commonly often iatrogenic complication invasive medical procedures. CONCLUSIONS: This is first report demonstrate embolism suspected be secondary tracking REFERENCE #1: Gursoy, S., Duger, C., Kaygusuz, K., Ozdemir Kol, I., Gurelik, B., Mimaroglu, 2012. Arterial Embolism Associated Mechanical Ventilation Deep Tracheal Aspiration. Pulmonology 2012, e416360. https://doi.org/10.1155/2012/416360 #2: Saeed, Alothman, Safavi, A., Donaldson, Ramcharan, DePaz, H., n.d. Exchange Resulting Rare Combination Pneumomediastinum, Pneumothorax, Massive Pneumoperitoneum, Subcutaneous Emphysema. Cureus 9. https://doi.org/10.7759/cureus.1489 #3: Thomas, Majuran, M., 2018. Venous embolus percutaneous dilatational tracheostomy: report. J Intensive Care Soc 19, 354–356. https://doi.org/10.1177/1751143718755015 DISCLOSURES: Speaker/Speaker's Bureau relationship Boehringer-Ingelheim Pharmaceuticals Please note: $5001 - $20000 Jaime Betancourt, source=Web Response, value=Honoraria Vapotherm, Inc 2014-Present Added 04/21/2021 2019-Present Advisory Committee Member 2020 No relevant relationships Scott Oh, Response Yuliya Zektser,