Correspondence Address:
Deepak K Tempe
Department of Anaesthesiology and Intensive Care, G.B. Pant Hospital, New Delhi - 110 002.
India

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A 63-year-old woman with a 12-year history of large multinodular goitre and difficulty in breathing in supine position underwent subtotal thyroidectomy. She also had weakness of the left side, which was diagnosed as motor neuron disease (MND). Postoperatively, the patient required ventilatory assistance due to inadequate respiratory effort and was tracheostomised four days later. The tracheostomy cuff was inflated with 5 to 7 mL of air to achieve minimal leak around the cuff. Despite normalizing thyroid status with thyroxine, the patient could not be weaned off ventilator due to progressive MND. After two months, a leak around the cuff was noticed, which resolved by inflation of additional air. This problem continued over the next few days. Chest radiograph revealed an over­distended tracheostomy tube cuff suggesting tracheomalacia, which was confirmed by fibreoptic bronchoscopy. In view of the progressive MND, no definitive treatment for tracheomalacia was offered. Over next few days, the leak persisted and the chest radiograph revealed a large overdistended cuff. (arrows). Nearly 25 to 30 mL of air was required to achieve adequate sealing effect.[Figure 1]