[Acute subglottic tracheal stenosis after resuscitation]

Area of Science:

• Critical Care Medicine
• Pulmonology
• Gastroenterology

Background:

• Critically ill patients often require mechanical ventilation following cardiac arrest.
• Prolonged intubation and mechanical ventilation can lead to airway complications.
• Hemodynamic instability and hypoperfusion are common in post-cardiac arrest care.

Observation:

• A 41-year-old patient developed acute shortness of breath and inspiratory stridor 7 days post-extubation after 27.5 hours of mechanical ventilation.
• Bronchoscopy revealed subtotal tracheal stenosis attributed to extensive fibrinous membranes.
• The patient also experienced gastric bleeding (Forrest IIc) from ischemic ulcers.

Findings:

• Tracheal stenosis was likely caused by prolonged endotracheal tube cuff pressure leading to local ischemia.
• General hypoperfusion and hemodynamic instability contributed to the ischemic gastric ulcers.
• This case illustrates a rare but severe complication following resuscitation and mechanical ventilation.

Implications:

• Clinicians should be vigilant for tracheal stenosis after prolonged mechanical ventilation, especially in patients with hemodynamic instability.
• Careful management of endotracheal tube cuff pressure is crucial to prevent airway ischemia.
• Early recognition and management of ischemic complications are vital in post-cardiac arrest care.