Asymmetric Tracheostomy Cuff Inflation Causing Air Leak and Inadequate Tidal Volume Delivery: A Case Report

We report a rare case of tracheostomy tube malfunction due to asymmetric cuff inflation, a complication scarcely discussed in medical literature and distinct from more commonly reported tracheostomy cuff herniation. This case highlights a less recognized cause of air leak and inadequate ventilation, contributing to the understanding of rare tracheostomy complications.A 71-year-old male, recovering from Ivor Lewis esophagectomy and requiring surgical tracheostomy for prolonged ventilatory support, presented with a persistent air leak and reduced tidal volume soon after tube placement. This occurred despite an adequate cuff pressure (28 cm H₂O) and confirmed correct tube positioning. Direct laryngoscopy revealed air escaping through the glottis with each delivered breath, with the tracheostomy cuff visibly intact and no herniation.The findings led to the diagnosis of asymmetric tracheostomy cuff inflation. The therapeutic intervention involved the replacement of the problematic tracheostomy tube with a new non-fenestrated tube. This intervention immediately and completely resolved the air leak and restored normal ventilation.This case underscores the importance of prompt recognition and considering asymmetric cuff inflation in the differential diagnosis of tracheostomy tube malfunction. Differentiating between tracheostomy cuff herniation and a merely asymmetric cuff is crucial for healthcare professionals to manage these situations effectively and in an evidence-based manner.