{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:08:16Z","timestamp":1772168896580,"version":"3.50.1"},"reference-count":23,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T00:00:00Z","timestamp":1743465600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns3:p>Tracheostomy tube migration is a rare but potentially life-threatening complication. We present the case of a 66-year-old male with chronic obstructive pulmonary disease, dual-chamber pacemaker implantation for chronic ischemic cardiomyopathy, and supraglottic squamous cell carcinoma. The patient developed respiratory distress due to intrabronchial migration of the tracheostomy tube. Initial evaluation revealed significant respiratory effort, inspiratory stridor, and an absent tube at the stoma site. Imaging and bronchoscopy confirmed the tube\u2019s presence in the left main bronchus with associated mucosal inflammation. The patient underwent bronchoscopic-guided tube removal and successful repositioning of a cuffed tracheostomy tube under spontaneous ventilation anaesthesia. Following stabilization, he was discharged with plans for a permanent tracheostomy. Tracheostomy tube migration presents a significant diagnostic and therapeutic challenge, particularly given the scarcity of studies involving adults with this complication. This case highlights the importance of early recognition, prompt imaging\u2014especially bronchoscopy\u2014and tailored management strategies, while emphasizing the active involvement of the patient and family in the care pathway. It also underscores the necessity for vigilant monitoring to prevent severe, potentially fatal, complications.<\/ns3:p>","DOI":"10.12688\/f1000research.163217.1","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T05:46:34Z","timestamp":1743486394000},"page":"372","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report- Prevention strategies for permanent tracheostomy tube migration into the left main bronchus in tracheostomized patients"],"prefix":"10.12688","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0279-6026","authenticated-orcid":false,"given":"Said","family":"Khallikane","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amine","family":"Bentahar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monsif","family":"Salek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayoub","family":"Belhadj","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Youn\u00e8s","family":"Aissaoui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,4,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"895-919","DOI":"10.4187\/respcare.02971","article-title":"Tracheostomy: Epidemiology, Indications, Timing, Technique, and Outcomes.","volume":"59","author":"N Cheung","year":"2014","journal-title":"Respir. Care."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"379-383","DOI":"10.22038\/ijorl.2020.44797.2473","article-title":"Factors Associated with Fracture and Migration of Tracheostomy Tube into Trachea in Children: A Case Series.","volume":"32","author":"P Parida","year":"2020","journal-title":"PubMed."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s12893-023-01960-5","article-title":"Tracheostomy-related indications, early complications and their predictors among patients in low resource settings: a prospective cohort study in the pre-COVID-19 era.","volume":"23","author":"D Nyanzi","year":"2023","journal-title":"BMC Surg."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"103350","DOI":"10.1016\/j.amjoto.2021.103350","article-title":"Retrospective analysis of post-tracheostomy complications.","volume":"43","author":"M Murray","year":"2021","journal-title":"Am. J. Otolaryngol."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1940-1949","DOI":"10.1056\/nejmra1811697","article-title":"Acute Upper Airway Obstruction.","volume":"381","author":"A Eskander","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1191-1197","DOI":"10.1007\/s00405-013-2618-6","article-title":"Endoscopic airway management of acute upper airway obstruction.","volume":"271","author":"N Choudhury","year":"2013","journal-title":"Eur. Arch. Otorrinolaringol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1093\/bja\/aet081","article-title":"Stoelting\u2019s Anesthesia and Co-existing Disease.","volume":"110","author":"C Weir","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"4519-4523","DOI":"10.1007\/s00405-021-06707-7","article-title":"Tracheostomy complications in otorhinolaryngology are rare despite the critical airway.","volume":"278","author":"J Ruohoalho","year":"2021","journal-title":"Eur. Arch. Otorrinolaringol."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"179-188","DOI":"10.4103\/2229-5151.164994","article-title":"An overview of complications associated with open and percutaneous tracheostomy procedures.","volume":"5","author":"S Stawicki","year":"2015","journal-title":"Int. J. Crit. Illn. Inj. Sci."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1186\/s12890-022-01862-x","article-title":"Central airway obstruction: is it time to move forward?","volume":"22","author":"F Guedes","year":"2022","journal-title":"BMC Pulm. Med."},{"key":"ref11","article-title":"Pediatric Tracheostomy.","author":"A Singh","year":"2023","journal-title":"PubMed."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1145-1156","DOI":"10.1002\/ppul.25873","article-title":"Diagnosis, management, and outcomes of pediatric tracheostomy-associated infections: A scoping review.","volume":"57","author":"J Morrison","year":"2022","journal-title":"Pediatr. Pulmonol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"69-75","DOI":"10.1016\/j.anl.2023.08.003","article-title":"Tracheostomy in otorhinolaryngology education and training programs: A Japanese nationwide survey.","volume":"51","author":"M Higashino","year":"2023","journal-title":"Auris Nasus Larynx."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e353-e356","DOI":"10.5546\/aap.2015.e353","article-title":"Rotura de la c\u00e1nula de traqueostom\u00eda: una causa rara de dificultad respiratoria en el ni\u00f1o traqueotomizado. Caso cl\u00ednico.","volume":"113","year":"2015","journal-title":"Arch. Argent. Pediatr."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"156-169","DOI":"10.4187\/respcare.08206","article-title":"AARC Clinical Practice Guideline: Management of Adult Patients with Tracheostomy in the Acute Care Setting.","volume":"66","author":"C Mussa","year":"2020","journal-title":"Respir. Care."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"18-30","DOI":"10.4037\/ccn2013518","article-title":"Tracheostomy Care and Complications in the Intensive Care Unit.","volume":"33","author":"L Morris","year":"2013","journal-title":"Crit. Care Nurse."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"326-330","DOI":"10.1080\/00016489.2016.1245864","article-title":"Predicting feeding tube and tracheotomy dependence in laryngeal cancer patients.","volume":"137","author":"J Lavo","year":"2017","journal-title":"Acta Otolaryngol."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e63881","DOI":"10.7759\/cureus.63881","article-title":"Revolutionizing Healthcare: How Telemedicine Is Improving Patient Outcomes and Expanding Access to Care.","volume":"16","author":"V Ezeamii","year":"2024","journal-title":"Cureus."},{"key":"ref19","article-title":"Tracheostomy Tube Change.","author":"J Ng","year":"2024","journal-title":"StatPearls."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"619-626","DOI":"10.1002\/lary.27500","article-title":"Mortality associated with tracheostomy complications in the United States: 2007-2016.","volume":"129","author":"J Cramer","year":"2018","journal-title":"Laryngoscope."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"313-321","DOI":"10.1007\/s00405-020-06126-0","article-title":"Tracheostomy care and decannulation during the COVID-19 pandemic. A multidisciplinary clinical practice guideline.","volume":"278","author":"A Rovira","year":"2020","journal-title":"Eur. Arch. Otorrinolaringol."},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.28635305.v1","article-title":"Peroperative bronshoscopy showing the tracheostomy tube within the left main bronchus, causing an inflammatory reaction and conforming to the bronchial wall.","author":"S Khallikane","year":"2025","journal-title":"figshare. Media."},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.28635308.v1","article-title":"Peroperative bronchoscopy showing the Intraoperative bronchoscopy performed through the tracheostomy orifice to facilitate the forceps extraction of a migrated tracheostomy tube lodged in the left main bronchus.","author":"S Khallikane","year":"2025","journal-title":"figshare. Media."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/14-372\/v1\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/14-372\/v1\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/14-372\/v1\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T05:00:10Z","timestamp":1750741210000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/14-372\/v1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,1]]},"references-count":23,"URL":"https:\/\/doi.org\/10.12688\/f1000research.163217.1","relation":{"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.179527.r379803","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.179527.r379799","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.179527.r379799","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.179527.r379803","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,1]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/14-372\/v1#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.179527.r379799, Rachid Benchanna, Service de pneumologie, HMA, Marrakech, 30 Apr 2025, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/14-372\/v1#referee-response-379799","order":0,"name":"referee-response-379799","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>said khallikane<\/b>; \n<i>Posted: 30 Apr 2025<\/i>; We thank the reviewer for their insightful remarks and appreciate the opportunity to clarify several points raised:  \n<b>Smoking Quantification:<\/b> The reference to \u201c35 years of tobacco\u201d was intended to convey the long-term exposure rather than a precise pack-year calculation. While the estimated consumption may appear modest numerically, our aim was to emphasize duration as a contributing factor in the clinical profile. \n<b>COPD Classification:<\/b> We note the importance of GOLD classification. While a detailed subgrouping was not explicitly included, we chose to describe the patient as a \u201cfrequent exacerbator\u201d receiving triple inhaled therapy (ICS, LABA, LAMA), which we felt sufficiently reflected the severity and management approach in clinical practice. \n<b>Bronchoscopy Technique:<\/b> Thank you for this important point. The case involved flexible bronchoscopy initially for diagnostic purposes, as is typical in our setting. The removal of the foreign body was performed via endoscopic guidance. While the exact instrumentation was not specified, the focus remained on the outcome and clinical significance. \n<b>Discussion on Bronchial Anatomy:<\/b> We acknowledge the reviewer\u2019s comment and understand that anatomically, the right main bronchus is typically more predisposed to foreign body migration. Our phrasing was intended to reflect the findings in this particular case rather than general anatomical patterns. \n<b>Case History and Progression:<\/b> We believe the case\u2019s progression is presented with sufficient detail to allow the reader to follow the diagnostic reasoning, clinical decisions, and therapeutic approach, while maintaining conciseness and readability.  We are grateful for the reviewer\u2019s thoughtful engagement and hope that this clarification supports the intent and structure of the submitted work.","URL":"https:\/\/f1000research.com\/articles\/14-372\/v1#referee-comment-13831","order":1,"name":"referee-comment-13831","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.179527.r379803, Noureddine Atmani, Mohamed V University of Rabat, Rabat, 10 May 2025, version 1, indexed","URL":"https:\/\/f1000research.com\/articles\/14-372\/v1#referee-response-379803","order":2,"name":"referee-response-379803","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>said khallikane<\/b>; \n<i>Posted: 10 May 2025<\/i>; thank you for you for yout throughful review, We appreciate your positive assessment and we are pleased that the case report was found sufficient to be sufficientlu detailed and relevant for clinical practice. We believe that the current content effectively adressses the key aspects of diagnosis, management and broader implications without requiring futher amendments.....","URL":"https:\/\/f1000research.com\/articles\/14-372\/v1#referee-comment-13869","order":3,"name":"referee-comment-13869","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":4,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}