{'fraction_non_alphanumeric': 0.02700457000415455, 'fraction_numerical': 0.009970918155380142, 'mean_word_length': 5.287206266318538, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Successful conservative management of a tracheal tear in a septic octogenarian.

An 87-year-old woman with a tracheal tear was admitted from an outside institution for surgical management. She had suffered a myocardial infarction complicated by cardiogenic shock 2 weeks before admission and had been intubated. In the days that followed, she had been extubated and reintubated twice. One week before admission, she had become febrile, and subcutaneous air was noted by chest radiography. A tracheostomy had been performed 3 days before the admission and the continued, requisite use of positive-pressure ventilation had resulted in massive subcutaneous emphysema of the trunk, arms, and face. Given her advanced age, positive blood cultures (Staphylococcus sp), and recent cardiac events, conservative management of her tracheal tear was advocated. She was taken to the operating room where fiberoptic bronchoscopy confirmed the presence of a 3-cm full-thickness longitudinal tear of the membranous portion of the trachea, ending approximately 0.5 cm from the carina. Separate 5.5F single-lumen cuffed endotracheal tubes (ETTs) were placed into the right and left mainstem bronchi via the tracheal stoma under bronchoscopic guidance (Fig 1). The cuffs were inflated, and positive-pressure ventilation of the lungs without further air leak from the tear was achieved by using the Y-piece adaptor from a standard double-lumen ETT (Fig 2). Daily chest x-rays were performed as well as daily bronchoscopy to assure that the right single-lumen ETT did not occlude the takeoff of the right upper lobe. The massive subcutaneous emphysema resolved within 4 days. Antibiotic therapy with vancomycin, cefepime, and metronidazole resulted in a resolution of her sepsis, and significant nutritional deficiencies were addressed with enteral feedings. The 5.5F ETTs were uneventfully replaced on postoperative day 7 (6.5F on the left and 7.0 on the right) to facilitate suctioning of pulmonary secretions. Intermittent bronchoscopic surveillance was performed, and the ETTs were replaced by a standard tracheostomy (#8 Shiley) on postoperative day 12. The tear was bronchoscopically noted to be healed by postoperative day 28. Despite experiencing catheter sepsis, intermittent delirium, Clostridium difficile enteritis, intermittent congestive heart failure, and the development of a significant sacral decubitus ulcer,