Acute and Critical Care

Pulmonary/Thoracic Surgery
Successful Management of Airway Emergency in a Patient with Esophageal Cancer: Samina Park, Hyun Joo Lee, Chang Hyun Kang, Young Tae Kim; Korean J Crit Care Med. 2015;30(2):135-138. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.135

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A 60-year-old man with advanced esophageal cancer was admitted for surgical placement of a feeding jejunostomy tube before commencement of chemoradiotherapy. His esophageal cancer had directly invaded the posterior tracheal wall, inducing a nearly total obstruction of the distal trachea. On the day before the surgery, respiratory failure developed due to tumor progression and tracheal edema. Tracheal intubation and mechanical ventilation were attempted without success. Application of veno-venous extracorporeal membrane oxygenation (ECMO) corrected the patient’s respiratory acidosis and relieved his dyspnea. With full ECMO support, he underwent tracheal stent insertion. Two hours later, he was weaned from ECMO support uneventfully. This was a successful case of tracheal stenting for airway obstruction under rescue veno-venous ECMO.

Citations

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An esophageal tumor producing life-threatening tracheal compression in a young adult was resuscitated with a self-inflating resuscitation bag
Rajnish Kumar, Nishant Sahay, Neeraj Kumar, Soumya Singh
Perioperative Care and Operating Room Management.2024; 34: 100365. CrossRef
Thoracic oesophageal cancer as a cause of stridor: a literature review
Robert Munashe Maweni, Venughanan Manikavasagar, Nicholas Sunderland, Sajid Chaudhry
BMJ Case Reports.2018; : bcr-2018-224872. CrossRef

Pulmonary
Total Unilateral Obstruction by Sputum Immediately after Tracheal Bougienage: Kyunam Kim, Jonghun Jun, Miae Jeong, Songlark Choi, Youngsun Lee; Korean J Crit Care Med. 2014;29(1):32-37. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.32

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Abstract PDF: A 25-year-old man developed tracheal stenosis due to prolonged intubation for five days. Immediately after bougienage, his left lung was not possible to ventilate and emergency tracheostomy was performed to produce ample space for airflow. Fiberoptic bronchoscopy showed that his left main bronchus was totally obstructed by sputum at the entrance of the superior and inferior lobar bronchi. Inadequate airway clearance increases the risk of infection and airway obstruction. We suggest chest physiotherapy be applied to all patients in the intensive care unit (ICU), especially patients with tracheal stenosis, due to its positive impact on pulmonary functional ability and ICU stay.

Ultrasound Guided Bronchoscopic Balloon Dilatation in the Management of Tracheal Stenosis: A Case Report: Jung Min Hong, Tae Kyun Kim, Ah Reum Cho, Do Won Lee, Yun Hee Han, Jae Young Kwon; Korean J Crit Care Med. 2012;27(2):139-142.; DOI: https://doi.org/10.4266/kjccm.2012.27.2.139

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Abstract PDF: We performed a balloon dilatation without a fluoroscopy monitoring by ultrasound. A 44 year old female patient was presented with subglottic stenosis, due to prolonged intubation. Although she had undergone tracheal resection and end-to-end anastomosis, the tracheal stenosis had recurred. She was scheduled for balloon dilatation. However, fluoroscopic guidance was not available, and thus, we used ultrasonographic monitoring as an alternative method. We performed a transverse scan, just cranial to the suprasternal notch, and we obtained a real time image of the trachea dilated by the balloon. We suggest that ultrasonographic monitoring is a useful adjunct to balloon dilatation in patients with tracheal stenosis.

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