Critical Care Innovations (Jun 2024)
Emergency bronchoscopy in a child with critical airway stenosis after tracheostomy: a case report
Abstract
Tracheal stenosis can develop as a consequence of prolonged endotracheal intubation or tracheostomy. A 14-year-old child had a history of left frontotemporal craniotomy after a fall from height one month later and tracheostomy was performed on the sixth postoperative day and decannulation was performed 20 days later. On the fifth day of post-decannulation, the child came to the emergency department with a complaint of difficulty breathing since three days. The patient was immediately moved to emergency operation theater. The patient was intubated with a 6 mm endotracheal tube, but no adequate tidal volume was delivered. Bronchoscopy was performed in the operating room. It showed a smooth, circumferential web 2 cm above the carina (supracarinal stenosis). To achieve ventilatory goals, a 6 mm endotracheal tube was removed and a microlayrngoscopy tube (MLS) of size 5.5 mm was negotiated with deflated cuff. Since the MLS tube was longer, it reached the proximal limit of the narrowed portion of the trachea. There was improvement in ventilation. To achieve proper ventilation, circumferential web was planned. The patient underwent emergency balloon dilation of trachea through rigid bronchoscopy. The balloon catheter was introduced into the bronchoscope, and the balloon was then inflated. As the balloon was inflated, it leads to stretching of the soft tissue and widening of the supracarinal space. The dilatation procedure / ballooning improved the ventilation dynamics. An endotracheal tube of 6mm size was inserted, and endotracheal tube was fixed beyond the stenotic segment above the carina to prevent recurrence of narrowing due to edema after the procedure. After balloon dilation, the patient was shifted to intensive care unit (ICU). The patient was extubated 24 hours after surgery. On the second postoperative day, the patient shifts from the ICU to the ward and on the fifth postoperative day, the patient was discharged from the hospital with the advice that repeated dilation may be required and dates for future follow-up. We present a case of emergency bronchoscopy in a child with critical airway stenosis after tracheostomy that was successfully managed.
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