Emergency Endotracheal Intubation With a Rigid Stylet of an Infant With Severe Subglottic Stenosis

Area of Science:

• Pediatric Critical Care
• Emergency Medicine
• Anesthesiology

Background:

• Subglottic stenosis is a common complication following endotracheal intubation in pediatric patients.
• This condition can lead to significant airway difficulties during subsequent respiratory events.
• Existing difficult airway algorithms guide management of respiratory failure, emphasizing invasive access as a last resort.

Observation:

• A 4-month-old infant presented with stridor and respiratory failure secondary to croup.
• The infant had a history of prior endotracheal intubation, which had resulted in severe subglottic stenosis.
• Tracheal intubation was challenging due to the narrowed subglottic segment.

Findings:

• Successful endotracheal intubation was achieved using a rigid endotracheal tube stylet.
• The stylet facilitated the passage of the endotracheal tube through the stenotic portion of the airway.
• This case highlights a potential alternative method for managing difficult airways caused by subglottic stenosis.

Implications:

• Emergency physicians should be aware of non-standard techniques for managing difficult airways.
• A rigid stylet can be a valuable tool for tracheal intubation in cases of severe subglottic stenosis.
• Consideration of this technique should follow evaluation of conventional methods and potential complications.