Fracture and migration of a metallic tracheostomy tube: anesthetic considerations and case review

Background Tracheostomy is commonly performed to maintain airway patency or to provide prolonged ventilatory support in elective and emergency settings. Although it offers substantial benefits, tracheostomy may be associated with early and late complications. Fracture and migration of a tracheostomy tube are exceptionally rare, with an incidence of less than 1 in 1000 cases. Such events can lead to life-threatening airway obstruction and present significant anesthetic and airway management challenges during retrieval. Case Presentation We report a 27-year-old male with a tracheostomy placed 18 years ago for prolonged ventilation after a road accident. He had used the same metallic tube without replacement or follow-up. Presenting with mild cough, blood-tinged sputum, and chest tightness, imaging revealed a metallic foreign body in the right main bronchus. Emergency rigid bronchoscopy under general anesthesia allowed successful retrieval of the fractured inner tube through the tracheostomy stoma. Recovery was uneventful. Literature review identified 16 similar case reports of fractured tracheostomy tubes. Both spontaneous and controlled ventilation techniques were used in these cases, emphasizing that anesthetic management should be individualized based on patient stability, airway conditions, and procedural requirements. Conclusions Fracture and migration of metallic tracheostomy tubes are rare but potentially life-threatening. Regular follow-up and timely tube replacement are vital for prevention. Effective management requires coordinated teamwork, careful anesthetic planning, and flexibility in ventilation strategies to ensure safety and good outcomes.