Improved percutaneous transtracheal ventilation for airway obstruction in tongue cancer: a case report

Patients with advanced-stage tongue cancer are often confronted with an increased risk of difficult airway management due to anatomical changes caused by prior surgeries and radiation therapy. These alterations may lead to acute airway obstruction and asphyxiation in critical situations, such as massive hematemesis, thereby necessitating the implementation of refined and context-specific airway management strategies.

We present the case of a 66-year-old male with recurrent tongue cancer who experienced a sudden episode of severe hematemesis, leading to acute respiratory distress and loss of consciousness. In this life-threatening situation, with limited resources, percutaneous transtracheal ventilation (PTV) was performed using basic, readily available equipment. The procedure was complemented by an intermittent oral-nasal occlusion technique to simulate breathing and maintain oxygenation. Despite challenges such as anatomical distortion and significant bleeding, these interventions successfully stabilized the patient's condition, raising oxygen saturation to 100%. Following stabilization, the patient underwent a complex tracheostomy.

This case underscores the effectiveness of combining fine-needle cricothyroid puncture with intermittent oral-nasal occlusion as a practical and resource-efficient method to maintain ventilation in emergency airway obstruction scenarios. This approach offers a valuable strategy for managing challenging airways in cancer patients, particularly when resources are scarce or time is critical.