Anterograde catheterization of severe tracheal stenosis as a difficult airway management option, followed by emergent tracheostomy (a case report)

Background: To describe the successful management of a patient with severe dyspnea and hypoxia due to tracheal stenosis by the application of a novel bridging technique-anterograde tracheal catheterization-prior to tracheostomy.

Case presentation: A 55-year-old woman entered the Emergency Department with severe dyspnea, tachypnea, and stridor and a pulse oximetry reading of 60 %. An attempt at intubation failed because of tracheal stenosis discovered 3-4 cm distal to the vocal cords, which had been formed as a complication of intubation the previous month. Cricothyrotomy could not be applied for failed airway management because the stenosis had formed distal to the cricothyroid membrane. Laryngeal mask airway ventilation did not improve the oxygenation to more than an arterial oxygen saturation (SpO2) of 70 %. Thus, anterograde insertion of a 12-F double-lumen central venous catheter was attempted, which sealed the 2-mm orifice of the stricture. Bag-valve-mask ventilation with this latter mode provided 80 % saturation as a bridge to an emergent bed-side tracheostomy.

Conclusions: "Anterograde tracheal catheterization" appears to be a relatively effective and easy-to-perform option for oxygenation in such tracheal stenosis cases before a definite but time-consuming tracheostomy can secure the airway.