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[Undetected tracheal tumours responsible for ventilator-dependency]
C Zimmermann1, L Freitag, B Schönhofer
1Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, Schmallenberg-Grafschaft, Germany. c.z.70@t-online.de
History And Clinical Findings:
Case 1 A patient with former carcinoma of the larynx became dependent on mechanical ventilation. She failed to be weaned from the respirator because of severe bronchial obstruction, therefore she was transferred to a weaning center. Case 2 A COPD patient with respirator dependency due to infectious exacerbation underwent percutaneous tracheostomy shortly after primary intubation. Status asthmaticus was considered to be the reason of following unsuccessful weaning.
Investigations, Diagnosis And Treatment:
Case 1 Performing a bronchoscopy the diagnosis of a central tumor (local recurrence) was found causing nearly total obstruction of the trachea. The ensuing treatment was restricted to palliation. Case 2 After transferral to the weaning center a small cell lung cancer located in the central tracheal was identified by bronchoscopy. The tumor masses were exstirpated by laser technique and the patient was weaned immediately afterwards. Chemotherapy and radiation of the mediastinum were performed.
Conclusions:
Fibreoptic bronchoscopy is an essential tool concerning diagnosis and treatment of tracheal tumors which may cause difficult weaning from mechanical ventilation. Every percutaneous tracheostomy should be performed with endoscopical guidance.