NIV support bronchoscopy by tracheostomy after decannulation failure: avoid new tracheostomy—case report and review analysis

Abstract

Abstract Background Decannulation is an essential step in liberating tracheostomised patients from mechanical ventilation. There is a paucity of literature on tracheostomy decannulation methods and procedures, leaving the decision to expert opinion and institutional guidelines. Failure to decannulate may result from several reasons, such as severe dysphagia, retention of copious secretions requiring invasive airway clearing techniques, or tracheal stenosis. Meanwhile, the combined use of either non-invasive ventilation during bronchoscopy has been reported as a successful strategy in different diagnostic and therapeutic clinical conditions. Case presentation We describe a patient admitted to the intensive care unit due to respiratory failure after a decannulation process and the use of non-invasive ventilation as rescue therapy during urgent flexible bronchoscopy to support this procedure and control acute hypercapnic respiratory failure and avoid recannulation process. Conclusions This case presents the rationale approach of using non-invasive ventilation during bronchoscopy to avoid decannulation failure by accumulation of secretions during this procedure.

Keywords

• Non-invasive ventilation
• Hypercapnic respiratory failure
• Tracheostomy decannulation
• Flexiblebronchoscopy