| CASE REPORT |
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| Year : 2021 | Volume
: 4
| Issue : 3 | Page : 209-212 |
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Failed airway despite securing the airway: A near-complete distal tracheal stenosis
K NJ Prakash Raju1, D Anandhi2, S Manu Ayyan2, N Ashok3, Bhukya Kiran Naik2
1 Department of Emergency Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
2 Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
3 Department of Forensic Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
Correspondence Address:
Dr. K NJ Prakash Raju
Department of Emergency Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry - 605 006
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/arwy.arwy_47_21
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Inability to ventilate or oxygenate can be catastrophic. Critical tracheal stenosis may present as a life-threatening airway emergency. We report a 25-year-male who presented to the Emergency Department in respiratory arrest. After endotracheal intubation, there was no tidal volume delivery despite generating high peak airway pressures. Unfortunately, even an emergency surgical airway did not succeed in providing adequate ventilation. Postmortem examination revealed near-total occlusion of the distal tracheal lumen. When a patient has refractory ventilatory failure due to possible airway obstruction, the acute care provider should consider distal tracheal stenosis as one among the differential diagnosis. Conventional approach to airway management, including surgical airway, may not be of help in the presence of distal tracheal stenosis. A skilled emergency physician should possess the ability to think out-of-the-box and be aware of novel techniques to achieve oxygenation and ventilation in a 'failed airway' of this nature. Though appropriate, fibreoptic intubation, extracorporeal membrane oxygenation or emergency thoracotomy may not be readily available or practically feasible options to manage a failed airway due to distal tracheal stenosis.
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