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Excessive dynamic airway collapse during general anesthesia: a case report.

Shunichi Murakami1, Shunsuke Tsuruta2, Kazuyoshi Ishida3

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Excessive dynamic airway collapse (EDAC) can cause high airway pressure during ventilation and is often misdiagnosed as asthma. Bronchoscopy is key to differentiating EDAC from bronchospasm, guiding appropriate treatment.

Keywords:
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Area of Science:

  • Anesthesiology
  • Respiratory Medicine
  • Critical Care

Background:

  • Excessive dynamic airway collapse (EDAC) is an infrequent cause of elevated airway pressure during mechanical ventilation.
  • EDAC is frequently misdiagnosed as asthma due to similar presenting symptoms.
  • Anesthesiologists may lack awareness of EDAC, contributing to diagnostic challenges.

Purpose of the Study:

  • To highlight the diagnostic challenges of Excessive Dynamic Airway Collapse (EDAC).
  • To differentiate EDAC from asthma exacerbations in clinical practice.
  • To emphasize appropriate management strategies for EDAC.

Main Methods:

  • A case presentation of a 70-year-old woman with asthma undergoing surgery.
  • Initial misdiagnosis of wheezing and high inspiratory pressure as an asthma attack.
  • Diagnostic confirmation via bronchoscopy and review of CT scans revealing tracheal and bronchial collapse.

Main Results:

  • The patient presented with symptoms mimicking asthma, including wheezing and high inspiratory pressures.
  • Bronchodilator therapy proved ineffective, prompting further investigation.
  • Bronchoscopy confirmed EDAC, characterized by expiratory collapse of the trachea and main bronchi.

Conclusions:

  • EDAC and bronchospasm share similar clinical presentations but require distinct treatments.
  • Bronchoscopy is a valuable tool for distinguishing between EDAC and bronchospasm.
  • Positive end-expiratory pressure (PEEP) is indicated for EDAC, while bronchodilators should be avoided.