A 72-year-old man presented to the high dependency unit following an elective incisional hernia repair. He was extubated in the immediate postoperative period. Following established type 2 respiratory failure (secondary to hospital-acquired pneumonia), he required tracheal intubation and was ventilated in the intensive care unit (ICU). He failed extubation and subsequently had a percutaneous single-stage dilational tracheostomy fitted as indicated. During the tracheostomy, while inflating the dilation balloon (used to dilate the trachea), the balloon burst in the trachea, at a pressure of 3 atmospheres. Following this, the entire dilating unit and tracheostomy tube were removed; no debris was left inside the trachea as confirmed by bronchoscope (used throughout the procedure). He made good recovery and was discharged to a surgical ward. This case report summarises the indications for tracheostomy, and reports the rare event of balloon rupture and how to manage it within the ICU setting.
2015 BMJ Publishing Group Ltd.