The Pressure Is On: Subglottic Jet Ventilation In Severe Tracheal Stenosis
Medically Challenging Case Report Poster
61 y/o female with asthma, diabetes, obesity, and prior tracheostomy presented with worsening dyspnea. ENT endoscopy showed patent glottis, but narrowed, tortuous airway. Patient was unable to lay flat. Concern for airway collapse led to awake fiberoptic exam in the OR. This demonstrated 15% patency 5.5 cm below the glottis without airway collapse. We induced and were able to mask ventilate, albeit with high pressures. The patient was suspended and subglottic jet ventilation via specialty tube above the stenosis was successful. Following laser and balloon dilation, the jet ventilator was advanced through the stenosis. Within several minutes an audible "sigh" was observed and oxygenation became increasingly difficult. After these interventions, however, the patient could be intubated with a 6.0 tube and was transferred to the ICU. She suffered bilateral pneumothoraces and pneumoperitoneum, but airway patency improved to 70% after edema decreased. She was extubated and avoided immediate tracheal resection.
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