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A Novel Rescue Technique for Difficult Intubation and Difficult Ventilation

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Tracheobronchomalacia causing end expiratory grunt post-intubation.

J Bhagvandas¹, J Henry¹

¹Department of Anaesthesia Northland District Health Board Whangarei New Zealand.

Anaesthesia Reports

|June 27, 2022

Summary

Tracheobronchomalacia, a rare airway collapse, was diagnosed intraoperatively via bronchoscopy. This case highlights the importance of recognizing end-expiratory grunts as a diagnostic clue.

Keywords:

airway assessment: coexisting disease central airway obstruction dynamic airway collapse tracheobronchomalacia

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Area of Science:

Anesthesiology
Pulmonology
Medical Diagnostics

Background:

Tracheobronchomalacia is a rare condition causing airway collapse during exhalation.
Diagnosis is infrequently made intraoperatively, often presenting asymptomatically or with subtle signs.

Observation:

A persistent, loud, end-expiratory grunt was noted immediately after tracheal tube cuff inflation during general anesthesia.
Flexible bronchoscopy revealed dynamic tracheal collapse distal to the carina upon expiration.
The patient underwent elective surgery for basal and squamous cell carcinomas.

Findings:

Tracheobronchomalacia was diagnosed intraoperatively in a 52-year-old male patient.
The characteristic end-expiratory grunt served as a key diagnostic indicator.
Advancing the tracheal tube and increasing PEEP effectively splinted the airway, resolving the collapse.

Implications:

An audible end-expiratory grunt post-intubation warrants further investigation for dynamic airway collapse.
Flexible bronchoscopy is a valuable tool for visualizing airway collapse in tracheobronchomalacia.
Prompt diagnosis and intervention can facilitate successful surgical management in affected patients.