# Unperceived bronchial bleeding complications during percutaneous dilatational tracheotomy: a case report and 3D simulation

## TL;DR

A patient had dangerous bleeding during a tracheotomy due to a guide wire injury, and 3D printing helped visualize the complication.

## Contribution

Demonstrates a rare bronchial bleeding complication and the use of 3D printing for visualization in critical care.

## Key findings

- Bleeding occurred at the bifurcation of segmental bronchus 9 and 10 due to a guide wire-induced mucosal lesion.
- 3D printing was used to create a detailed model of the patient's bronchial system to better understand the complication.
- Advancing the guide wire only to the tracheal carina under bronchoscopic control is recommended to prevent such injuries.

## Abstract

Percutaneous dilatational tracheostomy is an established technique for securing the airway in critically ill patients. One of the most common complications is bleeding around the incision or after injury to major vessels in anatomic proximity.

We report a case in which a thrombocytopenic patient experienced life-threatening bleeding during the procedure at the bifurcation between segmental bronchus 9 and 10, apparently caused by an unrecognized guide wire-induced mucosal lesion. Immediate extensive bronchoscopy and hemostatic interventions were required to ensure oxygenation. To better illustrate this complication, a patient-specific (1:1) three-dimensional model of the patient’s bronchial system was subsequently created using a 3D printer. In conclusion, 3d printing can help to visualize uncommon complications during intensive care interventions. It is recommended to advance the guide wire the guide wire only until the tracheal carina under bronchoscopic control.

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